Healthcare Provider Details

I. General information

NPI: 1790230985
Provider Name (Legal Business Name): MADELINE BACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NW 9TH ST STE 100
OKLAHOMA CITY OK
73106-7248
US

IV. Provider business mailing address

800 NW 9TH ST STE 100
OKLAHOMA CITY OK
73106-7248
US

V. Phone/Fax

Practice location:
  • Phone: 405-815-5050
  • Fax: 405-815-5051
Mailing address:
  • Phone: 405-815-5050
  • Fax: 405-815-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number106661
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: