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General NPI Number Information
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NPI Number | 1982336335
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Entity Type | Individual
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Provider Name | CAROLYN DIANNE DECLOUD-ATANASOVA RN
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Gender | Female
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 06/25/2022
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Provider Practice Location Address
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Address Line | 3524 NW 56TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4518
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Country | US
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Telephone | 405-606-6937
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Fax |
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Provider Business Mailing Address
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Address Line | 18009 CALDER RD
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City | EDMOND
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State | OK
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Zip | 73012-0041
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Country | US
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Telephone | 405-535-3346
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R0135602
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License Number State | OK
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