Most Relevant Information
Provider Data
| NPI Number: | 1003201039 |
| Provider Name: | MAKEDA GANT |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | APN.0991567-NP |
Most Important Dates
| Enumeration Date: | 04/06/2015 |
| Last Updated: | 10/28/2024 |
Provider Practice Location
1129 S ASPEN AVE
BROKEN ARROW
OK
740124859
Practice Location Phone/Fax
| Phone: | 9187649300 |
| Fax: | 9187649275 |
Provider Mailing Location
13600 E 86TH ST N
STE 100
OWASSO
OK
740558732
Provider Mailing Phone/Fax
| Phone: | 9182729313 |
| Fax: | 9184036311 |