Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 108337 | OK |
NPI | 1063030088 |
---|---|
Provider Name | Kristal Ladawn Vasquez |
First Address | Memphis, TN 38103-5513 |
Second Address | Tulsa, OK 74136-3922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 19/08/2021 |