Individual
LACIE JAI ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6721 NW 124TH TER, OKLAHOMA CITY, OK 73142-3124
(405) 201-0322
Mailing address
6721 NW 124TH TER, OKLAHOMA CITY, OK 73142-3124
(405) 201-0322
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
60670
OK
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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