EAST LAKE MEDICAL, PLLC

TYLER, TX
NPI1497494777
Entity TypeOrganization
Authorized ContactJENA DECANTER
Nurse Practitioner
903-650-8619
Organization Subpart ?No
Primary Taxonomy363L00000X Nurse Practitioner
Enumeration Date2022-06-03
Last Update Date2022-06-03
Business Address
EAST LAKE MEDICAL, PLLC
11980 STATE HIGHWAY 64 E STE G
TYLER, TX 75707-2541
Phone number: 903-650-8619
Mailing Address
EAST LAKE MEDICAL, PLLC
11980 STATE HIGHWAY 64 E STE G
TYLER, TX 75707-2541
Phone number: 903-650-8619
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