Individual
MRS. DIANA LYNN FAIRCHILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16414 W 760 RD, TAHLEQUAH, OK 74464-1675
(918) 708-9009
(918) 708-1714
Mailing address
16414 W 760 RD, TAHLEQUAH, OK 74464-1675
(918) 708-9009
(918) 708-1714
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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