Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 106258 | OK |
NPI | 1215451281 |
---|---|
Provider Name | Kyra Boler |
First Address | Norman, OK 73071-6485 |
Second Address | Norman, OK 73071-6485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2017 |
Last Update Date | 01/08/2017 |