Healthcare Provider Details

I. General information

NPI: 1447398045
Provider Name (Legal Business Name): MS. ELSIE M LYTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELSIE M JOY B.C.O.

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 S GARNETT RD #302
TULSA OK
74146-5231
US

IV. Provider business mailing address

4606 S GARNETT RD #302
TULSA OK
74146-5231
US

V. Phone/Fax

Practice location:
  • Phone: 918-664-6544
  • Fax: 918-664-0668
Mailing address:
  • Phone: 918-664-6544
  • Fax: 918-664-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNONE REQUIRED
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: