Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 1906 | OK |
NPI | 1588254700 |
---|---|
Provider Name | Jessica Rader |
First Address | Jenks, OK 74037-3653 |
Second Address | Jenks, OK 74037-3653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2021 |
Last Update Date | 21/01/2021 |