Healthcare Provider Details

I. General information

NPI: 1659917060
Provider Name (Legal Business Name): TERRI LYNN MARINO L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S DOUGLAS BLVD
MIDWEST CITY OK
73130-5270
US

IV. Provider business mailing address

1390 S DOUGLAS BLVD
MIDWEST CITY OK
73130-5270
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-5312
  • Fax:
Mailing address:
  • Phone: 405-455-5312
  • Fax: 405-455-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3346
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: