Healthcare Provider Details

I. General information

NPI: 1962657775
Provider Name (Legal Business Name): TAYLOR ELISE SARTIN GCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12445 S 18TH CIR
JENKS OK
74037-3663
US

IV. Provider business mailing address

12445 S 18TH CIR
JENKS OK
74037-3663
US

V. Phone/Fax

Practice location:
  • Phone: 405-590-4546
  • Fax:
Mailing address:
  • Phone: 405-590-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number81421
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: