Individual
MANDI FADDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
RT 3 BOX 2510, STILWELL, OK 74960
(918) 723-3181
Mailing address
RT 3 BOX 2510, STILWELL, OK 74960
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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