Healthcare Provider Details

I. General information

NPI: 1891941886
Provider Name (Legal Business Name): CYNTHIA LOVE NYDICK, D.O., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W TECUMSEH RD SUITE 205
NORMAN OK
73072-1810
US

IV. Provider business mailing address

PO BOX 722808
NORMAN OK
73070-9137
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-7100
  • Fax: 405-364-9112
Mailing address:
  • Phone: 405-360-7100
  • Fax: 405-364-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4220
License Number StateOK

VIII. Authorized Official

Name: DR. CYNTHIA LOVE NYDICK
Title or Position: PRESIDENT
Credential: D.O.
Phone: 405-360-7100