MEDICARE: PAMELA MICHELLE DE BOURG-BINGERT MSW

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1508383811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MICHELLE DE BOURG-BINGERT MSW

Provider Business Mailing Address
First Line	:	1011 E 67TH ST APT 1021
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3748
Country	:	US
Telephone Number	:	607-743-7719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 E 67TH ST APT 1021
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3748
Country	:	US
Telephone Number	:	607-743-7719
Fax Number	:

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

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	08/28/2017

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