MEDICARE: NICOLE LUNG

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912445149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LUNG

Provider Business Mailing Address
First Line	:	3806 N OAK GROVE DR
Second Line	:	APT. 612
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3533
Country	:	US
Telephone Number	:	405-408-3198
Fax Number	:	405-231-3705

Provider Business Practice Location Address
First Line	:	3806 N OAK GROVE DR
Second Line	:	APT. 612
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3533
Country	:	US
Telephone Number	:	405-408-3198
Fax Number	:	405-231-3705

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	02/08/2017

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Directions to “ NICOLE LUNG ” Practice Location

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