Individual
TAMARA JANE CAROL DAWN DEGENHARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4205 OK-66, EL RENO, OK 73036-4909
(405) 262-4875
(405) 319-7675
Mailing address
809 FIREFORK AVE, YUKON, OK 73099-0504
(405) 985-9940
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
91127
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
91127
BOARD OF NURSING LICENSE NUMBER
OK
Enumeration date
12/05/2018
Last updated
06/01/2023
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