Individual
VIRGINIA TIGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 E COPLIN ST, OKEMAH, OK 74859-4642
(918) 623-1424
Mailing address
1800 E COPLIN ST, OKEMAH, OK 74859-4642
(918) 623-1424
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
130491
OK
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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