Individual
JUDY CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6200
Mailing address
16722 E 636 RD, INOLA, OK 74036-3200
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
0080161
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0080161
RN LICENSE
OK
Enumeration date
09/21/2015
Last updated
09/21/2015
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