Healthcare Provider Details

I. General information

NPI: 1225097785
Provider Name (Legal Business Name): ANNE TIPAY MAGPURI CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARNOLD ST 72MDG/SGOMP
TINKER AFB OK
73145-8105
US

IV. Provider business mailing address

6408 BRIARWOOD LN
NICHOLS HILLS OK
73116-5612
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-2213
  • Fax:
Mailing address:
  • Phone: 405-842-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number52349
License Number StateDC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: