Individual
MR. PHILLIP ANTHONY REZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRACTICAL NURSE
Contact information
Practice address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
(580) 354-5270
(580) 354-5289
Mailing address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
(580) 354-5270
(580) 354-5289
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0021375
OK
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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