Healthcare Provider Details

I. General information

NPI: 1588598015
Provider Name (Legal Business Name): PAIGE ELIZABETH ENRIQUEZ APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 E INDIANOLA ST
BROKEN ARROW OK
74014-7324
US

IV. Provider business mailing address

7409 E INDIANOLA ST
BROKEN ARROW OK
74014-7324
US

V. Phone/Fax

Practice location:
  • Phone: 918-699-9011
  • Fax:
Mailing address:
  • Phone: 918-699-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number204467
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: