Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 92972 | OK |
NPI | 1194099655 |
---|---|
Provider Name | Julee Ann Riley |
First Address | Oklahoma City, OK 73112-5555 |
Second Address | Oklahoma City, OK 73112-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2012 |
Last Update Date | 02/06/2020 |