MEDICARE: MIKIE SCHREE SALAZAR APRN

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	205563	OK

General Provider Information

NPI Number	:	1669134144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKIE SCHREE SALAZAR APRN

Provider Business Mailing Address
First Line	:	268585 E COUNTY ROAD 44
Second Line	:
City	:	RINGWOOD
State	:	OK
Zip	:	73768-1108
Country	:	US
Telephone Number	:	405-642-1156
Fax Number	:

Provider Business Practice Location Address
First Line	:	268585 E COUNTY ROAD 44
Second Line	:
City	:	RINGWOOD
State	:	OK
Zip	:	73768-1108
Country	:	US
Telephone Number	:	405-642-1156
Fax Number	:

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

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	10/12/2021

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