Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R0081020 | OK |
NPI | 1003095183 |
---|---|
Provider Name | Jennifer Christa Pimentel |
First Address | Tulsa, OK 74136-8303 |
Second Address | Tulsa, OK 74136-8303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2007 |
Last Update Date | 02/03/2010 |