Basic Information
| Provider Information | |||||||||
| NPI: | 1215400544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINTERO | ||||||||
| FirstName: | ELIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 S YALE AVE | ||||||||
| Address2: | STE 1400 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184886687 | ||||||||
| FaxNumber: | 9184886098 | ||||||||
| Practice Location | |||||||||
| Address1: | 4456 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | KIEFER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740413029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186335246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2019 | ||||||||
| LastUpdateDate: | 03/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 86881 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.