Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 78873 | OK |
NPI | 1215442728 |
---|---|
Provider Name | Rebecca Kay Edwards |
First Address | Tulsa, OK 74104-4013 |
Second Address | Tulsa, OK 74104-4012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 16/01/2018 |