Individual
REIDA LORI WASSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2702 S 17TH ST, CHICKASHA, OK 73018-6408
(405) 320-5040
Mailing address
2702 S 17TH ST, CHICKASHA, OK 73018-6408
(405) 320-5040
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
809
OK
Other
Enumeration date
03/03/2008
Last updated
03/03/2008
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