Laretha Johnson-Vincent

NPI #1245713460 in Mangum, Oklahoma

Provider Information

NPI Number: 1245713460
Entity Type: Individual
Name: Laretha Johnson-Vincent
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Contractor
Enumeration Date: Sep 13, 2018
Last Updated: Sep 13, 2018

Practice Location

Address: 125 N OKLAHOMA AVE
City: Mangum
State: Oklahoma
ZIP Code: 73554-4279
Phone: (713) 876-0839

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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