Healthcare Provider Details

I. General information

NPI: 1093058448
Provider Name (Legal Business Name): MICHELLE BETH HERNANDEZ CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W MAIN ST
NORMAN OK
73069-6459
US

IV. Provider business mailing address

2121 W MAIN ST
NORMAN OK
73069-6459
US

V. Phone/Fax

Practice location:
  • Phone: 405-447-9433
  • Fax: 405-447-9433
Mailing address:
  • Phone: 405-447-9433
  • Fax: 405-447-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: