Healthcare Provider Details

I. General information

NPI: 1639385842
Provider Name (Legal Business Name): MRS. KAREN CRISTENE MINIELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 S WACO AVE
TULSA OK
74107-6810
US

IV. Provider business mailing address

4312 S WACO AVE
TULSA OK
74107-6810
US

V. Phone/Fax

Practice location:
  • Phone: 918-446-8281
  • Fax:
Mailing address:
  • Phone: 918-446-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: