Healthcare Provider Details

I. General information

NPI: 1821617077
Provider Name (Legal Business Name): MARY CAMILLE CHELF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 E 91ST ST
TULSA OK
74133-5834
US

IV. Provider business mailing address

10210 E 91ST ST
TULSA OK
74133-5834
US

V. Phone/Fax

Practice location:
  • Phone: 918-940-8500
  • Fax:
Mailing address:
  • Phone: 918-940-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number123090
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123090
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: