MEDICARE: TAMMY DIANE VERMEULEN NURSE PRACTITIONER

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	77115	OK
2	363LF0000X	Family Nurse Practitioner	77115	OK

General Provider Information

NPI Number	:	1598095143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY DIANE VERMEULEN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	4221 S WESTERN AVE STE 4005
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3436
Country	:	US
Telephone Number	:	405-644-5040
Fax Number	:	405-644-5039

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE STE 4005
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3436
Country	:	US
Telephone Number	:	405-644-5040
Fax Number	:	405-644-5039

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

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	09/28/2021

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Directions to “ TAMMY DIANE VERMEULEN NURSE PRACTITIONER” Practice Location

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