Provider Demographics
NPI:1235543141
Name:GREWE-NELSON, EMILY KATHRYN (DO)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:KATHRYN
Last Name:GREWE-NELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3316 E 21ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1927
Mailing Address - Country:US
Mailing Address - Phone:918-749-3533
Mailing Address - Fax:918-749-9789
Practice Address - Street 1:3316 E 21ST ST STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1927
Practice Address - Country:US
Practice Address - Phone:918-749-3533
Practice Address - Fax:918-749-9789
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019165207Q00000X
OK6172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200713610AMedicaid