=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619346954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEANNA NORRIS BSM, CPM, LM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2015
-----------------------------------------------------
Last Update Date | 08/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 E 15TH ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-6693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-630-0606
-----------------------------------------------------
Fax | 580-203-0923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 E 15TH ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-6693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-630-0606
-----------------------------------------------------
Fax | 580-203-0923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | MIDW0014
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------