Individual
MRS. NEYSA LOU HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PROVIDER
Contact information
Practice address
2420 S DOGWOOD AVE, BROKEN ARROW, OK 74012-1013
(918) 449-0091
(918) 449-0091
Mailing address
2420 S DOGWOOD AVE, BROKEN ARROW, OK 74012-1013
(918) 449-0091
(918) 449-0091
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
U082273901
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200329220
SOONER CARE PROVIDER
OK
Enumeration date
06/02/2011
Last updated
06/02/2011
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