Individual
JACKIE SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
(580) 298-6723
Mailing address
PO BOX 1030, ANTLERS, OK 74523-1030
(580) 298-2830
(580) 298-6723
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
33940
OK
Other
Enumeration date
04/17/2015
Last updated
04/17/2015
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