Healthcare Provider Details

I. General information

NPI: 1992251094
Provider Name (Legal Business Name): CYNTHIA STARR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GOINGSNAKE ST
TAHLEQUAH OK
74464-3133
US

IV. Provider business mailing address

800 GOINGSNAKE ST
TAHLEQUAH OK
74464-3133
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-4110
  • Fax: 918-458-4112
Mailing address:
  • Phone: 918-458-4110
  • Fax: 918-458-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR0085237
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: