Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 85746 | OK |
NPI | 1093280638 |
---|---|
Provider Name | Joleen Cervantez |
First Address | Tulsa, OK 74136-3361 |
Second Address | Tulsa, OK 74136-1907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 07/12/2018 |