Healthcare Provider Details

I. General information

NPI: 1780296947
Provider Name (Legal Business Name): CATHERINE A DEAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 E I 240 SERVICE RD
OKLAHOMA CITY OK
73135-2607
US

IV. Provider business mailing address

620 24TH AVE SW
NORMAN OK
73069-3913
US

V. Phone/Fax

Practice location:
  • Phone: 405-416-9703
  • Fax: 405-416-9704
Mailing address:
  • Phone: 405-217-9997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104973
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number104973
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: