Healthcare Provider Details

I. General information

NPI: 1831422328
Provider Name (Legal Business Name): DENISE WORDEN MCCONNELL RN, APN, GCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9020
US

IV. Provider business mailing address

27865 W 161ST ST S
BRISTOW OK
74010-2202
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-5874
  • Fax: 918-599-6150
Mailing address:
  • Phone: 918-247-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberR0025091
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: