Healthcare Provider Details

I. General information

NPI: 1386972131
Provider Name (Legal Business Name): CIE CHLOEE PSHIGODA CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 SUMMIT AVE
SKIATOOK OK
74070
US

IV. Provider business mailing address

8409 SUMMIT AVE
SKIATOOK OK
74070-5540
US

V. Phone/Fax

Practice location:
  • Phone: 918-808-0583
  • Fax:
Mailing address:
  • Phone: 918-808-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number117717
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: