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General NPI Number Information
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NPI Number | 1386991529
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Entity Type | Individual
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Provider Name | LYNN ANN TUDOR APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 1239 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-2311
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Country | US
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Telephone | 918-291-0004
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Fax | 918-296-3911
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Provider Business Mailing Address
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Address Line | 1717 S UTICA AVE STE A
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City | TULSA
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State | OK
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Zip | 74104-5346
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Country | US
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Telephone | 918-291-0004
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Fax | 918-296-3911
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 96089
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License Number State | OK
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