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NPI Code Detail

MEDICARE: MARENA DE JESUS APRN

MEDICARE: MARENA DE JESUS 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
1363LG0600XGerontology Nurse Practitioner219385OK

General Provider Information

NPI Number : 1942017959
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARENA DE JESUS APRN
Provider Business Mailing Address
First Line : 10304 EXTER AVE
Second Line :
City : YUKON
State : OK
Zip : 73099-7564
Country : US
Telephone Number : 321-276-7430
Fax Number :
Provider Business Practice Location Address
First Line : 14101 PARKWAY COMMONS DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-6012
Country : US
Telephone Number : 405-749-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2024
Last Update Date : 12/12/2024

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