BILLY JACK PREMO

MIDWEST CITY, OK
NPI1003839911
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: OK  R0025846)
Enumeration Date2006-07-25
Last Update Date2015-03-12
Business Address
-- BILLY JACK PREMO CRNA
2825 PARKLAWN DR
MIDWEST CITY, OK 73110-4201
Phone number: 405-360-7576
Mailing Address
-- BILLY JACK PREMO CRNA
PO BOX 10979
MIDWEST CITY, OK 73140-1979
Phone number: 405-360-7576
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