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Individual

MRS. AMELIA MARIE ISOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
B.A

Contact information

Practice address
618 BRYAN DR, DURANT, OK 74701-3462
(580) 920-0909
Mailing address
618 BRYAN DR, DURANT, OK 74701-3462
(580) 920-0909

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1679821912
NPI
OK
05
200453720A
OK
Enumeration date
09/06/2016
Last updated
09/06/2016
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