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General NPI Number Information
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NPI Number | 1265597553
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Entity Type | Individual
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Provider Name | NENETH OAKLEY PHUNG PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2733 SOUTH I-35 SERVICE ROAD
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City | MOORE
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State | OK
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Zip | 73160
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Country | US
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Telephone | 405-814-7845
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Fax |
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Provider Business Mailing Address
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Address Line | 5713 SE 87TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73135-6076
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Country | US
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Telephone | 405-869-7235
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1418
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License Number State | OK
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