Healthcare Provider Details

I. General information

NPI: 1255670006
Provider Name (Legal Business Name): MRS. CARRI MARGRETHE CORNISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S HARVARD AVE
TULSA OK
74114-3300
US

IV. Provider business mailing address

650 S PEORIA AVE
TULSA OK
74120-4429
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-4301
  • Fax: 918-560-1399
Mailing address:
  • Phone: 918-587-9471
  • Fax: 918-560-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: