Most Relevant Information
Provider Data
| NPI Number: | 1003390907 |
| Provider Name: | ANISSA MARIE MAYHEW |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/18/2018 |
| Last Updated: | 09/18/2018 |
Provider Practice Location
405 E EXCELSIOR AVE
VINITA
OK
743014226
Practice Location Phone/Fax
| Phone: | 9182456476 |
| Fax: | 9182563628 |
Provider Mailing Location
405 E EXCELSIOR AVE
VINITA
OK
743014226
Provider Mailing Phone/Fax
| Phone: | 9182456476 |
| Fax: | 9182563628 |