=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669510897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDI MARCELLE MURRELL NNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1923 S UTICA AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-6520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-744-2725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19420 E 36TH ST
-----------------------------------------------------
City | BROKEN ARROW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74014-4721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-691-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LN0005X
-----------------------------------------------------
Taxonomy Name | Critical Care Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | R65071
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------