MEDICARE: TAMARA L MADJID APRN

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	363LW0102X	Women's Health Nurse Practitioner	0078685	OK
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	0078685	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78685	OTHER	OK	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497908032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA L MADJID APRN

Provider Business Mailing Address
First Line	:	6600 S YALE AVE
Second Line	:	SUITE 1400
City	:	TULSA
State	:	OK
Zip	:	74136-3347
Country	:	US
Telephone Number	:	918-488-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 E 91ST ST
Second Line	:	SUITE 203
City	:	TULSA
State	:	OK
Zip	:	74133-5801
Country	:	US
Telephone Number	:	918-382-5399
Fax Number	:	918-382-5704

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	12/18/2012

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Directions to “ TAMARA L MADJID APRN” Practice Location

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