Individual
MONA JANE ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 N OKLAHOMA AVE, MANGUM, OK 73554-3009
(580) 782-3343
Mailing address
301 N OKLAHOMA AVE, MANGUM, OK 73554-3009
(580) 782-3343
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
736021103
PERSONAL CARE
OK
Enumeration date
01/30/2019
Last updated
01/30/2019
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