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General NPI Number Information
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NPI Number | 1003694068
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Entity Type | Individual
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Provider Name | MADISON COLCLAZIER RN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 6128 E 38TH ST
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City | TULSA
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State | OK
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Zip | 74135-5832
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Country | US
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Telephone | 539-240-7461
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Fax |
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Provider Business Mailing Address
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Address Line | 6128 E. 38TH ST. TULSA, OK. 74135
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City | TULSA
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State | OK
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Zip | 74135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 213924
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License Number State | OK
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