Individual
MRS. LISA C MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1400 N PECAN RD, PONCA CITY, OK 74604-4131
(580) 763-2782
Mailing address
1400 N PECAN RD, PONCA CITY, OK 74604-4131
(580) 763-2782
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
54549
OK
Other
Enumeration date
04/10/2015
Last updated
04/10/2015
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