Individual
VIVIAN TADLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
57533 MOCCASIN TRAIL RD, PRAGUE, OK 74864-1143
(405) 567-0054
Mailing address
57533 MOCCASIN TRAIL RD, PRAGUE, OK 74864-1143
(405) 567-0054
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
50524
OK
Other
Enumeration date
01/16/2020
Last updated
01/16/2020
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