Provider Demographics
NPI:1295136505
Name:NORDSTROM, KATHERINE CLARE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CLARE
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 E 102ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137
Mailing Address - Country:US
Mailing Address - Phone:918-625-6351
Mailing Address - Fax:
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-392-5470
Practice Address - Fax:918-294-6851
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200575490AMedicaid