Individual
MRS. MINI GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10501 E 91ST ST, SUITE ED, TULSA, OK 74133-5790
(918) 307-6920
(918) 307-6951
Mailing address
PO BOX 25277, OVERLAND PARK, KS 66225-5277
(918) 307-6920
(918) 307-6951
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1334
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200039230A
—
OK
01
—
P00878497
MEDICARE RAILROAD
—
Enumeration date
05/01/2006
Last updated
09/10/2013
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