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NPI Code Detail

MEDICARE: GRACE ELIZABETH SCORSONE PA-C

MEDICARE: GRACE ELIZABETH SCORSONE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantOK

General Provider Information

NPI Number : 1043054190
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ELIZABETH SCORSONE PA-C
Provider Business Mailing Address
First Line : 10413 GREENBRIAR PKWY
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7656
Country : US
Telephone Number : 405-691-4665
Fax Number :
Provider Business Practice Location Address
First Line : 10413 GREENBRIAR PKWY
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7656
Country : US
Telephone Number : 405-691-4665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2024
Last Update Date : 06/24/2024

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Directions to “ GRACE ELIZABETH SCORSONE PA-C” Practice Location

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