Individual
SUSAN L LAVICTOIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
940 NE 13TH ST, 3B3311, OKLAHOMA CITY, OK 73104-5008
(405) 271-5789
Mailing address
1122 NE 13TH ST, ORI236, OKLAHOMA CITY, OK 73117-1039
(405) 271-1515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1172
OK
Other
Enumeration date
03/11/2006
Last updated
07/08/2007
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