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General NPI Number Information
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NPI Number | 1750097622
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Entity Type | Individual
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Provider Name | CASSIDI MARTIN CNP-F
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Gender | Female
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1919 E MEMORIAL RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73131-1253
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Country | US
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Telephone | 405-341-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 18521 ALBERTO PL
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City | EDMOND
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State | OK
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Zip | 73012-2001
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Country | US
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Telephone | 405-203-2528
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0999125
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 211619
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R0117104
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1692409
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License Number State | CO
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