Healthcare Provider Details

I. General information

NPI: 1578104865
Provider Name (Legal Business Name): CHRISTINA KLUCZNY APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE JOSEPHA KLUCZNY

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

6161 S YALE AVE SAINT FRANCIS XAVIER CONVENT
TULSA OK
74136-1902
US

V. Phone/Fax

Practice location:
  • Phone: 918-550-2790
  • Fax:
Mailing address:
  • Phone: 918-550-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number132430
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: