Individual
WANDA LUANN BEESLEY GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EMT-P
Contact information
Practice address
3100 E ST HWY 78, TISHOMINGO, OK 73460
(580) 257-0499
Mailing address
3100 E ST HWY 78, TISHOMINGO, OK 73460
(580) 257-0499
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
9208
OK
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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