Individual
JESI MARIE TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 E 15TH ST, PAWHUSKA, OK 74056-1901
(918) 287-3232
Mailing address
PO BOX 1382, PAWHUSKA, OK 74056-1382
(918) 440-9240
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
0105139
OK
Other
Enumeration date
11/13/2009
Last updated
10/16/2014
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