Individual
LATESHNA D OLIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1714 7TH ST, WICHITA FALLS, TX 76301-4223
(940) 263-8344
Mailing address
1714 7TH ST, WICHITA FALLS, TX 76301-4223
(940) 263-8344
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16829038
—
TX
Enumeration date
08/10/2020
Last updated
08/10/2020
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