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General NPI Number Information
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NPI Number | 1225284771
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Entity Type | Organization
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Legal Business Name | ST JOHN SAPULPA
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 1004 E BRYAN
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City | SAPULPA
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State | OK
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Zip | 74066-1368
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Country | US
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Telephone | 918-224-4280
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Fax | 918-224-6290
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Provider Business Mailing Address
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Address Line | 1004 E BRYAN
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City | SAPULPA
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State | OK
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Zip | 74066-1368
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Country | US
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Telephone | 918-224-4280
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Fax | 918-224-6290
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MRS. DONNA SUE NAGEL
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Credential |
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Telephone | 918-224-4280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2310
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License Number State | OK
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