Basic Information
| Provider Information | |||||||||
| NPI: | 1780120212 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JAZZ'LYNN DURANT FEMALE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 S PEORIA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741204429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185879471 | ||||||||
| FaxNumber: | 9185601399 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 N DENVER AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741031806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185821200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2017 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | DURANT | ||||||||
| AuthorizedOfficialFirstName: | JAZZ'LYNN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9185601335 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | OK | Y | Agencies | Case Management |
No ID Information.