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NPI Code Detail

MEDICARE: MRS. MEGAN DERNAIKA APRN

MEDICARE: MRS. MEGAN DERNAIKA 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
1363LF0000XFamily Nurse PractitionerR0092977OK

General Provider Information

NPI Number : 1770962664
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MEGAN DERNAIKA APRN
Provider Business Mailing Address
First Line : 2501 N BLACKWELDER AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-1402
Country : US
Telephone Number : 405-208-5090
Fax Number :
Provider Business Practice Location Address
First Line : 2501 N BLACKWELDER AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-1402
Country : US
Telephone Number : 405-208-5090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2015
Last Update Date : 12/10/2018

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