Healthcare Provider Details

I. General information

NPI: 1700983129
Provider Name (Legal Business Name): NOCTURNA OF EDMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 W. 15TH ST SUITE 1
EDMOND OK
73013
US

IV. Provider business mailing address

PO BOX 248855 DEPT # 18
OKLAHOMA CITY OK
73124-8855
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-7124
  • Fax: 405-285-7125
Mailing address:
  • Phone: 405-600-1950
  • Fax: 405-600-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEWIS P ZEIDNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 763-432-8401