Individual
MS. MAGGIE LYNN PEMBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 N DENVER AVE, TULSA, OK 74103-1806
(918) 582-1200
(918) 560-1399
Mailing address
2705 S BEECH AVE, BROKEN ARROW, OK 74012-7306
(918) 645-8262
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
OK
Enumeration date
02/24/2022
Last updated
09/01/2022
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