Individual
DESTINIE ROSE VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14430 NS 3500, KONAWA, OK 74849-4901
(580) 925-2650
Mailing address
816 E 18TH ST, ADA, OK 74820
(580) 475-4826
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/07/2023
Last updated
09/07/2023
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