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Individual

WILLETTA RUTH GRAYSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
SERVICE PROVIDER

Contact information

Practice address
RR 1 BOX 686, IDABEL, OK 74745-9779
(580) 286-5102
(580) 286-5929
Mailing address
RR 1 BOX 686, IDABEL, OK 74745-9779
(580) 286-5102
(580) 286-5929

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
0810
OK

Other

Enumeration date
07/09/2009
Last updated
07/09/2009
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