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General NPI Number Information
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NPI Number | 1174995336
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE & URGENT CARE OF CHANDLER, LLC
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 405 N. INDUSTRIAL RD.
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City | CHANDLER
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State | OK
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Zip | 74834
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Country | US
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Telephone | 405-258-6711
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Fax | 405-258-6722
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Provider Business Mailing Address
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Address Line | 405 N. INDUSTRIAL RD.
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City | CHANDLER
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State | OK
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Zip | 74834
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Country | US
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Telephone | 405-258-6711
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Fax | 405-258-6722
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Authorized Official
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Title or Position | APRN-CNP
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Name | SHERRY DIANN MITCHELL
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Credential | APRN
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Telephone | 405-240-7059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R0080778
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License Number State | OK
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