Healthcare Provider Details

I. General information

NPI: 1689946360
Provider Name (Legal Business Name): MARSHA NAHRA, MD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 515
TULSA OK
74136-7823
US

IV. Provider business mailing address

6465 S YALE AVE STE 515
TULSA OK
74136-7823
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-4580
  • Fax: 918-502-4520
Mailing address:
  • Phone: 918-502-4580
  • Fax: 918-502-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number21143
License Number StateOK

VIII. Authorized Official

Name: MARSHA NAHRA
Title or Position: DOCTOR
Credential: MD
Phone: 918-502-4580