Healthcare Provider Details

I. General information

NPI: 1467179838
Provider Name (Legal Business Name): CHRISTINA MARIE ROBY DYRSSEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9212 N KELLEY AVE
OKLAHOMA CITY OK
73131-2419
US

IV. Provider business mailing address

6033 NW 63RD ST APT G
WARR ACRES OK
73132-7535
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-5070
  • Fax: 405-242-5071
Mailing address:
  • Phone: 405-431-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: