Doctor Name: | JESI MARIE TATUM |
NPI Number: | 1730416652 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 0105139 |
Business Practice Address: | 1101 E 15th St Pawhuska, OK - 740561901 |
Business Phone Number: | 9182873232 |
Business Fax Number: | |
Mailing Address: | Po Box 1382, PAWHUSKA |
State: | OK |
Postal Code: | 740561382 |
Phone Number: | 9184409240 |
Fax Number: | |
NPI Enumeration Date: | 11/13/2009 |
NPI Last Update Date: | 10/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WA2000X |
License Number: | 0105139 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Administrator |
Taxonomy Definition: |