Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R0026953 | OK |
NPI | 1003046558 |
---|---|
Provider Name | Ms. Sandra Jean Heath |
First Address | Owasso, OK 74055-5016 |
Second Address | Owasso, OK 74055-5016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2009 |
Last Update Date | 18/07/2009 |