Healthcare Provider Details

I. General information

NPI: 1174590731
Provider Name (Legal Business Name): MICHELE W MARANTO NURSE PRACTITIONER A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SE 19TH
EDMOND OK
73013-6618
US

IV. Provider business mailing address

1501 SE 19TH
EDMOND OK
73013-6618
US

V. Phone/Fax

Practice location:
  • Phone: 405-348-6611
  • Fax: 405-348-9280
Mailing address:
  • Phone: 405-348-6611
  • Fax: 405-348-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR63497
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: