Healthcare Provider Details

I. General information

NPI: 1942648324
Provider Name (Legal Business Name): ANGELA DAWN VINES APRN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HEALTHPLEX PKWY SUITE 200
NORMAN OK
73072-9738
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-2260
  • Fax: 405-307-5610
Mailing address:
  • Phone: 405-515-2260
  • Fax: 405-307-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberR0058473
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: