Provider Demographics
NPI:1326793530
Name:ARMSTRONG, MAXINE (ADMINISTRATION)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:ADMINISTRATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480961
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74148
Mailing Address - Country:US
Mailing Address - Phone:918-289-4907
Mailing Address - Fax:
Practice Address - Street 1:8310 E 73RD ST STE 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2914
Practice Address - Country:US
Practice Address - Phone:918-289-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37PO27190219376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator