Individual
LISA MICHELE SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 494-2200
Mailing address
6600 S YALE AVE STE 1400, TULSA, OK 74136-3331
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
205023
OK
363LG0600X
Gerontology Nurse Practitioner
205023
OK
Other
Enumeration date
08/23/2021
Last updated
01/16/2024
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