Individual
MISS ERICA PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4760 E 68TH ST, #267, TULSA, OK 74136
(918) 565-2710
Mailing address
4760 E 68TH ST, APT267, TULSA, OK 74136-4942
(918) 565-2710
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
D999730843
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006102757
SOONERCARE
OK
Enumeration date
04/10/2017
Last updated
04/10/2017
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