Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 88008 | OK |
NPI | 1487035770 |
---|---|
Provider Name | Joshua A. Moushon |
First Address | Tulsa, OK 74104-4000 |
Second Address | Tulsa, OK 74104-4012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 25/06/2015 |