MEDICARE: MARILYN KAY NEHLS MD

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	208000000X	Pediatrics Physician	1780	OK

General Provider Information

NPI Number	:	1568440824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN KAY NEHLS MD

Provider Business Mailing Address
First Line	:	3613 NW 56TH ST
Second Line	:	#150
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4526
Country	:	US
Telephone Number	:	405-949-5437
Fax Number	:	405-949-7860

Provider Business Practice Location Address
First Line	:	3613 NW 56TH ST
Second Line	:	#150
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4526
Country	:	US
Telephone Number	:	405-949-5437
Fax Number	:	405-949-7860

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/08/2007

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