Willetta Ruth Grayson, SERVICE PROVIDER

NPI #1619106853 in Idabel, Oklahoma

Provider Information

NPI Number: 1619106853
Entity Type: Individual
Name: Willetta Ruth Grayson, SERVICE PROVIDER
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Health Worker
Credential: SERVICE PROVIDER
Enumeration Date: Jul 9, 2009
Last Updated: Jul 9, 2009

Practice Location

Address: RR 1 BOX 686
City: Idabel
State: Oklahoma
ZIP Code: 74745-9779
Phone: (580) 286-5102

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Health Worker	172V00000X	Primary

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