Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 90610 | OK |
NPI | 1003239518 |
---|---|
Provider Name | Mrs. Kristen Lanae Rosenau |
First Address | Oklahoma City, OK 73116-1812 |
Second Address | Moore, OK 73160-2936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2014 |
Last Update Date | 04/02/2014 |