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General NPI Number Information
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NPI Number | 1720474703
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Entity Type | Individual
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Provider Name | SAMANTHA DAWN STRETESKY RD/LD, PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/21/2024
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Provider Practice Location Address
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Address Line | 1 S BRYANT AVE
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City | EDMOND
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State | OK
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Zip | 73034-6309
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Country | US
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Telephone | 405-271-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 1 S BRYANT AVE
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City | EDMOND
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State | OK
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Zip | 73034-6309
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Country | US
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Telephone | 405-271-2663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4449
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2041
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License Number State | OK
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