Individual
MRS. THERESA R BASHAM-TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5550 S GARNETT RD, TULSA, OK 74146-6831
(918) 665-2501
(918) 665-3966
Mailing address
3518 E VIRGIN PL, TULSA, OK 74115-3922
(918) 665-2501
(918) 665-3966
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0050354
OK
Other
Enumeration date
02/28/2012
Last updated
02/28/2012
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