Individual
LISA MARIE HEINEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
Mailing address
460 N 4TH ST, VINITA, OK 74301-2620
(918) 323-5923
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/01/2021
Last updated
04/28/2022
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