Basic Information
| Provider Information | |||||||||
| NPI: | 1073990602 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL OKLAHOMA DIABETES CENTER APRN CNP NP-C PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 24TH AVE NW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058014050 | ||||||||
| FaxNumber: | 4057018988 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 24TH AVE NW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058014050 | ||||||||
| FaxNumber: | 4057018988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2015 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MELTON | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
| AuthorizedOfficialMiddleName: | DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4055460468 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN, CNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 76737 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.