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Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner

Provider NPI: 1770058463

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 405-949-3393  Fax: 409-945-5493

Business Mailing Address:
Tel: 405-949-3393  Fax: 405-945-5493

NPI Information:
NPI: 1770058463
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363L00000X





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