Healthcare Provider Details

I. General information

NPI: 1346548344
Provider Name (Legal Business Name): MRS. NORMA FAYE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 BROADWAY EXT SUITE #210
OKLAHOMA CITY OK
73116-8237
US

IV. Provider business mailing address

2301 NW 122ND ST APT 514
OKLAHOMA CITY OK
73120-8447
US

V. Phone/Fax

Practice location:
  • Phone: 405-563-0498
  • Fax:
Mailing address:
  • Phone: 405-476-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: