Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R0048957 | OK |
NPI | 1033172614 |
---|---|
Provider Name | Mary J Jung |
First Address | Oklahoma City, OK 73112-5556 |
Second Address | Oklahoma City, OK 73112-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 28/02/2018 |