Healthcare Provider Details

I. General information

NPI: 1063876985
Provider Name (Legal Business Name): MONICA ROXANA TUBBESING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S DOUGLAS BLVD STE 304
OKLAHOMA CITY OK
73150-1018
US

IV. Provider business mailing address

33620 ACME RD
MACOMB OK
74852-5702
US

V. Phone/Fax

Practice location:
  • Phone: 505-622-3063
  • Fax: 405-732-0022
Mailing address:
  • Phone: 405-333-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0110487
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: