Individual
JEANETTE CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11109 SURREY HILLS BLVD, YUKON, OK 73099-8155
(405) 373-2400
Mailing address
PO BOX 660, PIEDMONT, OK 73078-0660
(405) 373-2400
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
82129
OK
363L00000X
Nurse Practitioner
Primary
82129
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
439590YNM8
—
OK
Enumeration date
07/22/2015
Last updated
05/27/2016
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