Provider Demographics
NPI:1821816265
Name:CAMMACK, JULIANNE (APRN)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:CAMMACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 E 26TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4926
Mailing Address - Country:US
Mailing Address - Phone:918-261-7932
Mailing Address - Fax:
Practice Address - Street 1:7134 S YALE AVE STE 500
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6352
Practice Address - Country:US
Practice Address - Phone:918-392-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK220042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily