Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 108491 | OK |
NPI | 1578107819 |
---|---|
Provider Name | Victoria Janssen Kyle |
First Address | Oklahoma City, OK 73112-4418 |
Second Address | Oklahoma City, OK 73112-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 30/10/2019 |