Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 201309 | OK |
NPI | 1033703137 |
---|---|
Provider Name | Lisa Diane Johnston |
First Address | Tulsa, OK 74133-5722 |
Second Address | Tulsa, OK 74104-4243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2021 |
Last Update Date | 01/03/2021 |