Provider Demographics
NPI:1508479304
Name:GUNN, ANGELA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:GUNN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35620 EW 1260
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-6903
Mailing Address - Country:US
Mailing Address - Phone:405-802-9736
Mailing Address - Fax:
Practice Address - Street 1:2508 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3131
Practice Address - Country:US
Practice Address - Phone:405-585-2030
Practice Address - Fax:405-585-2859
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0082167163W00000X
OK200221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse