Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 29015 | OK |
NPI | 1255592952 |
---|---|
Provider Name | Dr. Stephanie Deter Pickett |
First Address | Edmond, OK 73013-8504 |
Second Address | Edmond, OK 73013-8504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 06/08/2015 |