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NPI Code Detail

MEDICARE: BLANCA CHARLES RN

MEDICARE: BLANCA CHARLES RN
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
1163WC0400XCase Management Registered Nurse98202OK
2163WD0400XDiabetes Educator Registered Nurse21420039OK
3171M00000XCase Manager/Care CoordinatorOK

General Provider Information

NPI Number : 1619730173
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLANCA CHARLES RN
Provider Business Mailing Address
First Line : 11479 S 264TH EAST AVE
Second Line :
City : COWETA
State : OK
Zip : 74429-6750
Country : US
Telephone Number : 918-407-4999
Fax Number :
Provider Business Practice Location Address
First Line : 4502 E 41ST ST
Second Line :
City : TULSA
State : OK
Zip : 74135-2536
Country : US
Telephone Number : 918-660-3071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2024
Last Update Date : 02/06/2024

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Directions to “ BLANCA CHARLES RN” Practice Location

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