Individual
LANICA WILLABY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
307 E CHEROKEE ST, WAGONER, OK 74467-4729
(918) 485-7991
Mailing address
307 E CHEROKEE ST RM 215, WAGONER, OK 74467-4729
(918) 485-7991
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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