Healthcare Provider Details

I. General information

NPI: 1811720279
Provider Name (Legal Business Name): TAELOR BUENO CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 14TH ST
OKLAHOMA CITY OK
73108-7022
US

IV. Provider business mailing address

1329 SW 14TH ST
OKLAHOMA CITY OK
73108-7022
US

V. Phone/Fax

Practice location:
  • Phone: 214-215-6958
  • Fax:
Mailing address:
  • Phone: 214-215-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMIDW0050
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: