Individual
DIANA KOONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1139 N 4220 RD, HUGO, OK 74743-8513
(469) 562-3713
Mailing address
1139 N 4220 RD, HUGO, OK 74743-8513
(469) 562-3713
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0069021
OK
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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