MEDICARE: THUNDER HEALTHCARE APRN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1982219697	OTHER	OK	NPPES

General Provider Information

NPI Number	:	1144829441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THUNDER HEALTHCARE APRN PLLC

Provider Business Mailing Address
First Line	:	1000 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3630
Country	:	US
Telephone Number	:	405-926-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3630
Country	:	US
Telephone Number	:	405-926-0353
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAURA MORENO
Credential	:	APRN
Telephone Number	:	405-926-0353

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	10/19/2020

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