Individual
WANDA LANELL GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
RR 1 BOX 3060, CLINTON, OK 73601-9303
(580) 331-3300
(580) 331-3565
Mailing address
RR 1 BOX 3060, CLINTON, OK 73601-9303
(580) 331-3300
(580) 331-3565
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
34858
OK
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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