Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 59822 | OK |
N | 363LA2200X | Nurse Practitioner - Adult Health | 59822 | OK |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 59822 | OK |
NPI | 1013569524 |
---|---|
Provider Name | Pamela Sue Woodward |
First Address | Jenks, OK 74037-2833 |
Second Address | Tulsa, OK 74136-1992 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2019 |
Last Update Date | 15/07/2019 |