Provider Demographics
NPI:1174995336
Name:FAMILY MEDICINE & URGENT CARE OF CHANDLER, LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE & URGENT CARE OF CHANDLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-CNP
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-240-7059
Mailing Address - Street 1:405 N. INDUSTRIAL RD.
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834
Mailing Address - Country:US
Mailing Address - Phone:405-258-6711
Mailing Address - Fax:405-258-6722
Practice Address - Street 1:405 N. INDUSTRIAL RD.
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834
Practice Address - Country:US
Practice Address - Phone:405-258-6711
Practice Address - Fax:405-258-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0080778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty