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General NPI Number Information
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NPI Number | 1487498275
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Entity Type | Individual
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Provider Name | MOLLY PANGESTU
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Gender | Female
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Dates
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Enumeration Date | 06/25/2024
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Last Update Date | 06/25/2024
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Provider Practice Location Address
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Address Line | 5020 E 68TH ST
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City | TULSA
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State | OK
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Zip | 74136-3307
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Country | US
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Telephone | 918-492-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 9547 E 81ST ST APT 715
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City | TULSA
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State | OK
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Zip | 74133-8118
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Country | US
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Telephone |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 6256
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License Number State | OK
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