Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 13334 | OK |
NPI | 1033216791 |
---|---|
Provider Name | Donna J Krutka |
First Address | Tulsa, OK 74104 |
Second Address | Tulsa, OK 74104-5638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 13/01/2011 |