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General NPI Number Information
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NPI Number | 1134785736
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Entity Type | Individual
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Provider Name | JEANETTE GOWDY LPN
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Gender | Female
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 7302 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-7027
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Country | US
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Telephone | 918-591-2510
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Fax | 855-855-4102
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Provider Business Mailing Address
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Address Line | 7302 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-7027
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Country | US
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Telephone | 918-591-2510
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Fax | 855-855-4102
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 0022562
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License Number State | OK
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