Stacey Ann Ellsworth

NPI #1427321207 in Tulsa, Oklahoma

Provider Information

NPI Number: 1427321207
Entity Type: Individual
Name: Stacey Ann Ellsworth
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Technician, Other
Enumeration Date: Feb 9, 2012
Last Updated: Feb 9, 2012

Practice Location

Address: 6333 E SKELLY DR
City: Tulsa
State: Oklahoma
ZIP Code: 74135-6106
Phone: (918) 633-0325

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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