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Individual

MR. EARL JAY DETHLOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
REGISTERED NURSE

Contact information

Practice address
604 S WALNUT ST, STILLWATER, OK 74074-4222
(405) 372-2202
Mailing address
604 S WALNUT ST, STILLWATER, OK 74074-4222
(405) 372-2202

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
73631
OK

Other

Enumeration date
10/21/2019
Last updated
10/21/2019
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