Most Relevant Information
Provider Data
NPI Number: | 1003062423 |
Provider Name: | JACKIE SUE TARR LPN |
Entity Type: | Individual |
Taxonomy Code: | 164W00000X |
Specialty: | Licensed Practical Nurse |
License Number: | L0018866 |
Most Important Dates
Enumeration Date: | 08/18/2008 |
Last Updated: | 08/18/2008 |
Provider Practice Location
1417 MCGRAW DR
PONCA CITY
OK
746012948
Practice Location Phone/Fax
Phone: | 5807651926 |
Fax: |
Provider Mailing Location
1417 MCGRAW DR
PONCA CITY
OK
746012948
Provider Mailing Phone/Fax
Phone: | 5807651926 |
Fax: |