Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 4361 | OK |
NPI | 1457392409 |
---|---|
Provider Name | Caryn Jean Roelofs |
First Address | Tulsa, OK 74107-2705 |
Second Address | Tulsa, OK 74107-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 09/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200078640A | (05) | OK |