Basic Information
| Provider Information | |||||||||
| NPI: | 1962535831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUENJI | ||||||||
| FirstName: | NJANJA | ||||||||
| MiddleName: | MARGARET | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1334 N LANSING AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741065907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185872171 | ||||||||
| FaxNumber: | 9182956914 | ||||||||
| Practice Location | |||||||||
| Address1: | MORTON COMPREHENSIVE HEALTH SERVICES | ||||||||
| Address2: | 1334 N. LASING AVE | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741065907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185872171 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 06/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1643 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 100768880J | 05 | OK | MEDICAID | 37-1832 | 01 | OK | MEDICARE | OTHER | 37-1834 | 01 | OK | MEDICARE | OTHER | 37-1803 | 01 | OK | MEDICARE | OTHER | 100768880F | 05 | OK | MEDICAID | 100768880I | 05 | OK | MEDICAID |