Provider Demographics
NPI:1639385842
Name:MINIELLY, KAREN CRISTENE
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:CRISTENE
Last Name:MINIELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 S WACO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-6810
Mailing Address - Country:US
Mailing Address - Phone:918-446-8281
Mailing Address - Fax:
Practice Address - Street 1:4312 S WACO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-6810
Practice Address - Country:US
Practice Address - Phone:918-446-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider