MEDICARE: EMILY ELIZABETH MCNULTY MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720607047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ELIZABETH MCNULTY MD

Provider Business Mailing Address
First Line	:	2008 S DELAWARE PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-5922
Country	:	US
Telephone Number	:	918-200-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	5916 S KNOXVILLE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-7805
Country	:	US
Telephone Number	:	918-200-1319
Fax Number	:

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

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	03/22/2023

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