Individual
SUSAN NICKELBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1316 SW BINKLEY ST, OKLAHOMA CITY, OK 73119-2323
(405) 410-4226
Mailing address
1316 SW BINKLEY ST, OKLAHOMA CITY, OK 73119-2323
(405) 410-4226
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
R082786016
OK
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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