Healthcare Provider Details

I. General information

NPI: 1316181084
Provider Name (Legal Business Name): JILL DENISE HOLLEMAN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2009
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

1705 E 19TH ST STE 302
TULSA OK
74104-5410
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3916
  • Fax:
Mailing address:
  • Phone: 918-748-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0057934
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: