Healthcare Provider Details

I. General information

NPI: 1710668199
Provider Name (Legal Business Name): SARA BETH MARR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

IV. Provider business mailing address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

V. Phone/Fax

Practice location:
  • Phone: 580-718-4501
  • Fax: 580-718-4581
Mailing address:
  • Phone: 580-718-4501
  • Fax: 580-718-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number214793
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: