Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 22950 | OK |
N | 2080P0216X | Pediatric Rheumatologist | 22950 | OK |
NPI | 1700113289 |
---|---|
Provider Name | Dr. Andrea L Sestak |
First Address | Oklahoma City, OK 73131-1250 |
Second Address | Yukon, OK 73099-6777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2009 |
Last Update Date | 23/06/2016 |