Healthcare Provider Details

I. General information

NPI: 1649379603
Provider Name (Legal Business Name): NEDENA ANN NEWMAN PIMENTEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NEDENA ANN RITCHIE RN

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S. 129TH EAST AVE #100
TULSA OK
74134
US

IV. Provider business mailing address

4500 S. 129TH EAST AVE #100
TULSA OK
74134
US

V. Phone/Fax

Practice location:
  • Phone: 918-624-4042
  • Fax: 214-775-4407
Mailing address:
  • Phone: 918-624-4042
  • Fax: 214-775-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR0041299
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: