Healthcare Provider Details

I. General information

NPI: 1427511088
Provider Name (Legal Business Name): VICTORIA SUNSHINE ELIZABETH DICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 SQUIRREL RD
TUTTLE OK
73089-7498
US

IV. Provider business mailing address

4103 S YALE AVE STE B
TULSA OK
74135-6002
US

V. Phone/Fax

Practice location:
  • Phone: 405-637-3581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: