Healthcare Provider Details

I. General information

NPI: 1548239379
Provider Name (Legal Business Name): SHARON ELLEN NOEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E TAFT AVE
SAPULPA OK
74066-6033
US

IV. Provider business mailing address

1305 E TAFT AVE
SAPULPA OK
74066-6033
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-8425
  • Fax: 918-224-8426
Mailing address:
  • Phone: 918-224-8425
  • Fax: 918-224-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2644
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: