Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 16883 | OK |
N | 207RC0200X | Critical Care Medicine | 16883 | OK |
Y | 207RP1001X | Pulmonary Disease | 16883 | OK |
N | 207RS0012X | Sleep Medicine | 16883 | OK |
NPI | 1679532170 |
---|---|
Provider Name | Suzanne Renee Olive |
First Address | Tulsa, OK 74115-4957 |
Second Address | Tulsa, OK 74104-5415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E27653 | (02) | |
H90060663001 | BLUE CROSS BLUE SHIELD (01) |