Healthcare Provider Details

I. General information

NPI: 1043553019
Provider Name (Legal Business Name): EDNA C HULLEY BOCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 24TH AVE NW SUITE 110
NORMAN OK
73069-6543
US

IV. Provider business mailing address

1321 SUNSET DR
NORMAN OK
73069-5352
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3344
  • Fax: 405-310-3340
Mailing address:
  • Phone: 405-310-3344
  • Fax: 405-310-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number58
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: