Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1063995363 |
---|---|
Provider Name | Annabelle Morgan Demoss |
First Address | Tulsa, OK 74107-4811 |
Second Address | Tulsa, OK 74107-4811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2018 |
Last Update Date | 12/09/2018 |