Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 109616 | OK |
NPI | 1013409945 |
---|---|
Provider Name | Mr. Kristopher Wayne Mcdonald |
First Address | Tulsa, OK 74104-5642 |
Second Address | Tulsa, OK 74104-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2018 |
Last Update Date | 08/11/2018 |