MEDICARE: NORMA BLACK

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1881303410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMA BLACK

Provider Business Mailing Address
First Line	:	4817 NW 65TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-6830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4817 NW 65TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-6830
Country	:	US
Telephone Number	:	405-201-8418
Fax Number	:

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

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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Directions to “ NORMA BLACK ” Practice Location

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