Individual
LISA ANN TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.D.
Contact information
Practice address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
Mailing address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1737
OK
Other
Enumeration date
06/06/2011
Last updated
06/06/2011
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