Healthcare Provider Details

I. General information

NPI: 1700642022
Provider Name (Legal Business Name): MEREQ CONSULTANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE STE 350
TULSA OK
74133-5772
US

IV. Provider business mailing address

21571 E 40TH PL S
BROKEN ARROW OK
74014-8776
US

V. Phone/Fax

Practice location:
  • Phone: 918-615-3750
  • Fax:
Mailing address:
  • Phone: 918-815-7671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: QUEEN OYOMERE ERUE
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 918-815-7671