Healthcare Provider Details

I. General information

NPI: 1043354228
Provider Name (Legal Business Name): PREMIERE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 24TH AVE NW STE 101
NORMAN OK
73069-6666
US

IV. Provider business mailing address

3261 24TH AVE NW STE 101
NORMAN OK
73069-6666
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-6432
  • Fax: 405-364-0090
Mailing address:
  • Phone: 405-364-6432
  • Fax: 405-364-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BREANNA DAWN WROBLEWSKI
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 405-928-7500