Healthcare Provider Details

I. General information

NPI: 1972939031
Provider Name (Legal Business Name): GENEVIEVE CHRISTINE EGGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 W 55TH PL STE 119
TULSA OK
74107-9108
US

IV. Provider business mailing address

12401 N MACARTHUR BLVD 2502
OKLAHOMA CITY OK
73142-3032
US

V. Phone/Fax

Practice location:
  • Phone: 918-486-9996
  • Fax: 800-260-7966
Mailing address:
  • Phone: 616-502-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: