Bontrager, Jacqueline

Bontrager, Jacqueline is an sole proprietor health care provider with primary practice located at 3015 E Skelly Dr Suite 103, Tulsa OK 74105-6317. She recently has only one registered license in Agencies / Community/Behavioral Health, which is considered as her primary health care specialty. Bontrager, Jacqueline can be contacted via phone (918) 712-0859.

Contact Information

Primary practice address
3015 E Skelly Dr Suite 103 Tulsa OK 74105-6317
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Agencies / Community/Behavioral Health 251S00000X

Profile Details

NPI number 1245655448
LBN Legal business name Bontrager, Jacqueline
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 25th, 2014
Last updated Feb 25th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245655448 NPPES
Oklahoma MEDICAID 100746170G

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