Healthcare Provider Details

I. General information

NPI: 1447148069
Provider Name (Legal Business Name): TERA OSS RNC-OB, IBCLC, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 NW 152ND ST
EDMOND OK
73013-2127
US

IV. Provider business mailing address

4801 INTEGRIS PKWY
EDMOND OK
73034-8864
US

V. Phone/Fax

Practice location:
  • Phone: 918-853-1072
  • Fax:
Mailing address:
  • Phone: 918-853-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-318707
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: