Individual
MS. CORIE DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9716 RIVERSIDE PKWY, TULSA, OK 74137-7447
(918) 528-4897
Mailing address
9716 RIVERSIDE PKWY, TULSA, OK 74137-7447
(918) 299-4333
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
APA2180
OK
Other
Enumeration date
01/08/2013
Last updated
12/07/2015
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