Healthcare Provider Details

I. General information

NPI: 1154330710
Provider Name (Legal Business Name): JANET IRENIE GEARIN M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10159 E 11TH ST
TULSA OK
74128-3058
US

IV. Provider business mailing address

3728 S BRADEN PL
TULSA OK
74135-5510
US

V. Phone/Fax

Practice location:
  • Phone: 918-835-5033
  • Fax:
Mailing address:
  • Phone: 918-835-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number237515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: