Individual
MIRANDA LYNNE SISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5484 W ANTHONY RD, TERLTON, OK 74081-4002
(539) 777-8069
Mailing address
5484 W ANTHONY RD, TERLTON, OK 74081-4002
(539) 777-8069
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/10/2025
Last updated
04/10/2025
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