Individual
ALISSA MARIE BANNERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6100 S WALKER AVE, OKLAHOMA CITY, OK 73139-7026
(405) 634-4400
Mailing address
8530 SW 74TH ST UNIT 6B8530SW, OKLAHOMA CITY, OK 73169-1209
(405) 496-9535
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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