Individual
SIEDRA CROUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
(918) 256-3628
Mailing address
PO BOX 253, KETCHUM, OK 74349-0253
(918) 782-8262
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/09/2015
Last updated
03/09/2015
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