Provider Demographics
NPI:1235213182
Name:BAUMAN, MARGIE SUE (NP)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:SUE
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-459-8824
Mailing Address - Fax:918-307-2239
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:STE 280
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-459-8824
Practice Address - Fax:918-307-2239
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062949363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100198130AMedicaid
OK76.0639661-0009OtherPVN BCBSOK
OK100198130AMedicaid
OK242600501Medicare PIN