Healthcare Provider Details

I. General information

NPI: 1093381949
Provider Name (Legal Business Name): NATALLI ISABELLE CREGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 24TH AVE NW STE 110
NORMAN OK
73069-6556
US

IV. Provider business mailing address

201 S CREEKDALE DR APT 103
NORMAN OK
73072-5036
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-5306
  • Fax: 405-310-4934
Mailing address:
  • Phone: 405-365-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: