Provider Demographics
NPI:1366962300
Name:VARUGHESE, SHANTY (APRN)
Entity type:Individual
Prefix:
First Name:SHANTY
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NE 10TH ST STE 5050
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5418
Mailing Address - Country:US
Mailing Address - Phone:405-271-7770
Mailing Address - Fax:405-271-1006
Practice Address - Street 1:800 NE 10TH ST STE 2100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-8707
Practice Address - Fax:405-271-2976
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0072132163WW0101X
OK72132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory