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NPI Code Detail

MEDICARE: MRS. MARIE MARIANNE MCCUNE NP-C

MEDICARE: MRS. MARIE MARIANNE MCCUNE NP-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
1363LF0000XFamily Nurse PractitionerF10190768OK

General Provider Information

NPI Number : 1639712326
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARIE MARIANNE MCCUNE NP-C
Provider Business Mailing Address
First Line : 5300 N INDEPENDENCE AVE STE 280
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-5555
Country : US
Telephone Number : 405-945-4587
Fax Number : 580-249-4269
Provider Business Practice Location Address
First Line : 1805 W GARRIOTT RD
Second Line :
City : ENID
State : OK
Zip : 73703-5526
Country : US
Telephone Number : 580-977-1826
Fax Number : 580-249-4269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2019
Last Update Date : 02/03/2020

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