Individual
EMMA PENDERGAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
U
Contact information
Practice address
10430 N 152ND EAST AVE, OWASSO, OK 74055-4867
(623) 313-0385
Mailing address
10430 N 152ND EAST AVE, OWASSO, OK 74055-4867
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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