Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R0062209 | OK |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 20101919 | OK |
N | 363LP2300X | Nurse Practitioner - Primary Care | 20101919 | OK |
NPI | 1083928303 |
---|---|
Provider Name | Jennifer Lee Unruh |
First Address | Oklahoma City, OK 73139-2544 |
Second Address | Oklahoma City, OK 73139-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2010 |
Last Update Date | 24/03/2011 |