Individual
JEAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3804 N LAND AVE, OKLAHOMA CITY, OK 73112-6515
(405) 820-6156
Mailing address
3804 N LAND AVE, OKLAHOMA CITY, OK 73112-6515
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/10/2015
Last updated
04/10/2015
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