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General NPI Number Information
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NPI Number | 1528736097
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Entity Type | Individual
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Provider Name | JENNIFER SUE SASSIN APRN, CPNP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1101 W MAIN ST # 112
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City | COLLINSVILLE
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State | OK
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Zip | 74021-3112
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Country | US
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Telephone | 918-553-8613
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Fax |
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Provider Business Mailing Address
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Address Line | 735 E 129TH PL S
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City | JENKS
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State | OK
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Zip | 74037
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Country | US
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Telephone | 918-629-7233
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 201598
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License Number State | OK
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