Provider Information for 1497027221
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THERESA YU
Sex: Female
NPI: 1497027221
Last Updated: 2012-02-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1497027221 | ||||||||
| Enumeration Date | 2012-02-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3035 N TUCKER AVE SHAWNEE, OK 74804-2284 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 3035 N TUCKER AVE SHAWNEE, OK 74804-2284 United States Phone: 580-298-3001 | Fax: | ||||||||
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