Organization
F.G.M.A. ,LLC.
Active
Other names
Family and Geriatric Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN B GRANDLE APRN (NURSE PRACTITIONER)
(405) 917-7590
Entity
Organization
Contact information
Practice address
5622 N PORTLAND AVE, #102, OKLAHOMA CITY, OK 73112-2096
(405) 917-7590
(405) 917-7595
Mailing address
5622 N PORTLAND AVE, #102, OKLAHOMA CITY, OK 73112-2096
(405) 917-7590
(405) 917-7595
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0028064
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100216830D
—
OK
01
—
R0028064
SUSAN GRANDLE LIC #
OK
Enumeration date
02/28/2007
Last updated
06/04/2015
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