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1497494777
EAST LAKE MEDICAL, PLLC
TYLER, TX
NPI
1497494777
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Entity Type
Organization
Authorized Contact
JENA DECANTER
Nurse Practitioner
903-650-8619
Organization Subpart ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
Enumeration Date
2022-06-03
Last Update Date
2022-06-03
Business 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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Mailing Address
EAST LAKE MEDICAL, PLLC
11980 STATE HIGHWAY 64 E STE G
TYLER, TX 75707-2541
Phone number: 903-650-8619
Copy
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