1649379603 NPI number — MRS. NEDENA ANN NEWMAN PIMENTEL APRN

Table of content: MRS. NEDENA ANN NEWMAN PIMENTEL APRN (NPI 1649379603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649379603 NPI number — MRS. NEDENA ANN NEWMAN PIMENTEL APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIMENTEL
Provider First Name:
NEDENA
Provider Middle Name:
ANN NEWMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RITCHIE
Provider Other First Name:
NEDENA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649379603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 S. 129TH EAST AVE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-624-4042
Provider Business Mailing Address Fax Number:
214-775-4407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 S. 129TH EAST AVE
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-624-4042
Provider Business Practice Location Address Fax Number:
214-775-4407
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SA2200X , with the licence number:  R0041299 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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