Healthcare Provider Details

I. General information

NPI: 1578774865
Provider Name (Legal Business Name): NANCY A CERSONSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W MEMORIAL RD
OKLAHOMA CITY OK
73142-2015
US

IV. Provider business mailing address

PO BOX 218
LOWELL AR
72745-0218
US

V. Phone/Fax

Practice location:
  • Phone: 57-736-7004
  • Fax: 405-720-3910
Mailing address:
  • Phone: 866-317-3801
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number28891
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number57007866
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberQ2524
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number46111
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: