Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R0064236 | OK |
NPI | 1235191602 |
---|---|
Provider Name | Rhonda L Mattingly |
First Address | Tulsa, OK 74104-4012 |
Second Address | Tulsa, OK 74104-4012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 17/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200100800A | (05) | OK |