Basic Information
| Provider Information | |||||||||
| NPI: | 1598246332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANFIELD | ||||||||
| FirstName: | MARAH | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 W WRANGLER BLVD | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748681917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053823650 | ||||||||
| FaxNumber: | 4053826028 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 W WRANGLER BLVD | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748681917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053034611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2018 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 114009 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.