MEDICARE: MARY BASS APRN-CNP

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	363LA2100X	Acute Care Nurse Practitioner	R0032267	OK
2	363LC0200X	Critical Care Medicine Nurse Practitioner	R0032267	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	500018800	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336136175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BASS APRN-CNP

Provider Business Mailing Address
First Line	:	6600 S YALE AVE
Second Line	:	SUITE 1400
City	:	TULSA
State	:	OK
Zip	:	74136-3347
Country	:	US
Telephone Number	:	918-488-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	6151 S YALE AVE
Second Line	:	SUITE A-100
City	:	TULSA
State	:	OK
Zip	:	74136-1907
Country	:	US
Telephone Number	:	918-494-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	12/21/2016

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Directions to “ MARY BASS APRN-CNP” Practice Location

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