Individual
DANIEL WAYNE SISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107
(918) 671-3987
Mailing address
1111 W 17TH ST, TULSA, OH 74107
(918) 671-3987
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/03/2021
Last updated
10/03/2021
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