Healthcare Provider Details

I. General information

NPI: 1578515086
Provider Name (Legal Business Name): JULIE M REDINGTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE M BENANZER PA-C

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE SUITE 305
TULSA OK
74136-1907
US

IV. Provider business mailing address

6151 S YALE AVE SUITE 305
TULSA OK
74136-1907
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-9494
  • Fax: 918-494-9459
Mailing address:
  • Phone: 918-494-9494
  • Fax: 918-494-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1399
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: