Individual
JAWAUNN QUINDELL GLAZE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1414 SW 89TH ST STE B, OKLAHOMA CITY, OK 73159-6312
(405) 676-5313
Mailing address
10847 NE 8TH TERRACE, MIDWEST CITY, OK 73130-5308
(405) 408-0689
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/11/2023
Last updated
10/23/2023
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