Individual
VANESSA BOSHUIZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12020 E 31ST ST, TULSA, OK 74146-2001
(918) 798-3111
Mailing address
12020 E 31ST ST, TULSA, OK 74146-2001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36966
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2017
Last updated
08/07/2020
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