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General NPI Number Information
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NPI Number | 1053137034
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Entity Type | Organization
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Legal Business Name | COMPOSURE SOLUTION LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 1 W 41ST ST
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City | SAND SPRINGS
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State | OK
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Zip | 74063-2752
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Country | US
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Telephone | 918-816-9443
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Fax |
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Provider Business Mailing Address
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Address Line | 9001 W 51ST ST
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City | TULSA
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State | OK
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Zip | 74107-8547
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Country | US
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Telephone | 918-815-9443
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | STEPHANIE ANN DURHAM
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Credential | NP
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Telephone | 918-815-9443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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