Individual
DEIA MARIE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 S WILLOW ST, PAULS VALLEY, OK 73075-3833
(405) 238-7311
Mailing address
PO BOX 635, PAULS VALLEY, OK 73075-0635
(405) 238-7311
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/19/2021
Last updated
07/19/2021
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