| NPI | 1073967246 |
|---|---|
| Former Name | MARYSUE ELIZABETH SLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 50272) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: OK R0050272) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK F0816002) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2017-05-11 |