Healthcare Provider Details

I. General information

NPI: 1891182333
Provider Name (Legal Business Name): ANGELA GENOVESE APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HEALTHPLEX PKWY SUITE 201
NORMAN OK
73072-9738
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-5720
  • Fax: 405-307-5721
Mailing address:
  • Phone: 405-307-6668
  • Fax: 405-701-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR80959
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: