Individual
MOLLY GRACE BURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10013 VELLETRI AVE, YUKON, OK 73099-8585
(405) 317-7754
Mailing address
10013 VELLETRI AVE, YUKON, OK 73099-8585
(405) 317-7754
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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