Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2417 | OK |
NPI | 1023122660 |
---|---|
Provider Name | Mrs. Jeanne Elizabeth Heyser-Easterly |
First Address | Tulsa, OK 74121-1228 |
Second Address | Tulsa, OK 74127-9003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 15/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H97860 | (02) | OK |