Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 72422 | OK |
NPI | 1134207616 |
---|---|
Provider Name | Miss Olivia Gene York |
First Address | Tulsa, OK 74104-4012 |
Second Address | Tulsa, OK 74104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 13/08/2018 |