MEDICARE: SONDRA SMOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	0063282	OK

General Provider Information

NPI Number	:	1023476462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONDRA SMOCK

Provider Business Mailing Address
First Line	:	7813 S UNION AVE APT 414
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-2743
Country	:	US
Telephone Number	:	918-268-4958
Fax Number	:

Provider Business Practice Location Address
First Line	:	7813 S UNION AVE APT 414
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-2743
Country	:	US
Telephone Number	:	918-268-4958
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2016
Last Update Date	:	01/30/2016

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Directions to “ SONDRA SMOCK ” Practice Location

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