Healthcare Provider Details

I. General information

NPI: 1861035958
Provider Name (Legal Business Name): SAEEDA SULTANA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S BRYANT AVE
EDMOND OK
73013-6028
US

IV. Provider business mailing address

4641 W NICKLAS AVE APT C
OKLAHOMA CITY OK
73132-6931
US

V. Phone/Fax

Practice location:
  • Phone: 405-348-7982
  • Fax:
Mailing address:
  • Phone: 405-501-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number116672
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116672
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: