Healthcare Provider Details

I. General information

NPI: 1083738017
Provider Name (Legal Business Name): DOROTHY E HERRON BA BHRS CPRP CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ALAMEDA ST
NORMAN OK
73071-5229
US

IV. Provider business mailing address

324 N LOUISA AVE
SHAWNEE OK
74801-6718
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-5100
  • Fax: 405-573-3958
Mailing address:
  • Phone: 405-788-7819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: