Healthcare Provider Details

I. General information

NPI: 1538676838
Provider Name (Legal Business Name): OMURKAN MIRA FINLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MADISON OAK DR
SAN ANTONIO TX
78258-3913
US

IV. Provider business mailing address

520 MADISON OAK DR
SAN ANTONIO TX
78258-3913
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-4000
  • Fax: 440-922-0145
Mailing address:
  • Phone: 210-297-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP136666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: