Doctor Name: | DR. JENNIFER WALL GIBBENS |
NPI Number: | 1598712291 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 14758 |
Business Practice Address: | 9001 S 101st East Ave Suite 350 Tulsa, OK - 741335708 |
Business Phone Number: | 9182936200 |
Business Fax Number: | 9182936245 |
Mailing Address: | 9001 S 101st East Ave, Suite 350 TULSA |
State: | OK |
Postal Code: | 741335708 |
Phone Number: | 9182936200 |
Fax Number: | 9182936245 |
NPI Enumeration Date: | 05/28/2006 |
NPI Last Update Date: | 03/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 14758 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |