Individual
JIMANN MARIE FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1215 NW 25TH ST, OKLAHOMA CITY, OK 73106-5629
(405) 525-2525
Mailing address
2419 NW 3RD ST, OKLAHOMA CITY, OK 73107-6937
(405) 248-6943
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0056198
OK
Other
Enumeration date
08/25/2010
Last updated
08/25/2010
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