Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LPO101 | OK |
N | 222Z00000X | Podiatrist | LPO101 | OK |
Y | 224P00000X | Prosthetist | LPO101 | OK |
NPI | 1265969596 |
---|---|
Provider Name | Mrs. Sarah Lorraine Matthews |
First Address | Tulsa, OK 74104-4614 |
Second Address | Tulsa, OK 74104-4614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 17/05/2017 |