| NPI | 1306118377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA L POITEVINT Owner 918-790-2890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 4825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4840) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK R0074165) | |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2012-02-06 |