Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 928 | OK |
NPI | 1376692228 |
---|---|
Provider Name | Stephanie C Crall |
First Address | Oklahoma City, OK 73139-9401 |
Second Address | Oklahoma City, OK 73139-9401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 30/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100839070 | (05) | OK |