Individual
JENNA MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6658
Mailing address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6658
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0133628
OK
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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