Healthcare Provider Details

I. General information

NPI: 1639358708
Provider Name (Legal Business Name): TERESA A BRADSHAW CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA A RAINS CRNFA

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 W MEMORIAL RD SUITE 300
OKLAHOMA CITY OK
73120-9320
US

IV. Provider business mailing address

4120 W MEMORIAL RD SUITE 300
OKLAHOMA CITY OK
73120-9320
US

V. Phone/Fax

Practice location:
  • Phone: 405-748-3300
  • Fax: 877-657-5008
Mailing address:
  • Phone: 405-748-3300
  • Fax: 877-657-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberR0036252
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: