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NPI Code Detail

MEDICARE: THERESA DIANNE STENMARK

MEDICARE:   THERESA DIANNE STENMARK
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
1363LF0000XFamily Nurse PractitionerR80656OK

General Provider Information

NPI Number : 1477010056
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA DIANNE STENMARK
Provider Business Mailing Address
First Line : 11920 WICKFORD PL
Second Line :
City : YUKON
State : OK
Zip : 73099-8390
Country : US
Telephone Number : 919-480-7303
Fax Number :
Provider Business Practice Location Address
First Line : 7410 S MACARTHUR BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73169-6908
Country : US
Telephone Number : 405-680-4075
Fax Number : 405-680-4095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2019
Last Update Date : 03/01/2019

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Directions to “ THERESA DIANNE STENMARK ” Practice Location

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