MEDICARE: SHERYL A. STANDAGE N.P.

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
1	363L00000X	Nurse Practitioner	R0029568	OK

General Provider Information

NPI Number	:	1548389000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL A. STANDAGE N.P.

Provider Business Mailing Address
First Line	:	800 NE 10TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5418
Country	:	US
Telephone Number	:	405-271-8778
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 NE 10TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5418
Country	:	US
Telephone Number	:	405-271-8778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	12/03/2012

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