Healthcare Provider Details

I. General information

NPI: 1801405618
Provider Name (Legal Business Name): KAREN DURHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 E 71ST PL APT 2121
TULSA OK
74136-3967
US

IV. Provider business mailing address

1812 E 71ST PL APT 2121
TULSA OK
74136-3967
US

V. Phone/Fax

Practice location:
  • Phone: 316-308-0290
  • Fax:
Mailing address:
  • Phone: 316-308-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: