Individual
QUAILLA MARRIANNE HAZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 W GRAND AVE, PONCA CITY, OK 74601-5123
(580) 762-1462
(580) 765-7299
Mailing address
620 W GRAND AVE, PONCA CITY, OK 74601-5123
(580) 762-1462
(580) 765-7299
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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