Provider Demographics
NPI:1568440824
Name:NEHLS, MARILYN KAY (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAY
Last Name:NEHLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:KAY
Other - Last Name:NEHLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3613 NW 56TH ST
Mailing Address - Street 2:#150
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4526
Mailing Address - Country:US
Mailing Address - Phone:405-949-5437
Mailing Address - Fax:405-949-7860
Practice Address - Street 1:3613 NW 56TH ST
Practice Address - Street 2:#150
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4526
Practice Address - Country:US
Practice Address - Phone:405-949-5437
Practice Address - Fax:405-949-7860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F71462Medicare UPIN