Healthcare Provider Details

I. General information

NPI: 1932425121
Provider Name (Legal Business Name): MONICA CORDERO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W 11TH ST
TULSA OK
74127
US

IV. Provider business mailing address

12423 E 33RD ST
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-3100
  • Fax:
Mailing address:
  • Phone: 918-289-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number82621
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: