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General NPI Number Information
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NPI Number | 1265701676
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Entity Type | Organization
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Legal Business Name | SNB, LLC DBA PERSONAL HEALTH PARTNERS
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 2000 E 15TH ST SUITE 300B
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City | EDMOND
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State | OK
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Zip | 73013-6697
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Country | US
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Telephone | 405-330-5755
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Fax | 405-330-5796
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Provider Business Mailing Address
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Address Line | 2000 E 15TH ST SUITE 300B
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City | EDMOND
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State | OK
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Zip | 73013-6617
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Country | US
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Telephone | 405-330-5755
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Fax | 405-330-5796
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Authorized Official
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Title or Position | OWNER / CLINICAL DIRECTOR
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Name | NAN A BERTONE
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Credential | RN, CLNC
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Telephone | 918-519-2919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLIA 37D0921553
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License Number State | OK
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