Individual
ETTA PEARL DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4638 SE 29TH ST, DEL CITY, OK 73115-3429
(405) 670-4644
(405) 670-4444
Mailing address
4638 SE 29TH ST, DEL CITY, OK 73115-3429
(405) 670-4644
(405) 670-4444
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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