Doctor Name: | MARYSUE ELIZABETH FARRIS |
NPI Number: | 1073967246 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | R0050272 |
Business Practice Address: | 2900 S Telephone Rd Suite 250 Moore, OK - 731602968 |
Business Phone Number: | 4052377500 |
Business Fax Number: | |
Mailing Address: | 35737 Hamilton Rd, WANETTE |
State: | OK |
Postal Code: | 748786025 |
Phone Number: | 4058086160 |
Fax Number: | |
NPI Enumeration Date: | 04/14/2016 |
NPI Last Update Date: | 04/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WA2000X |
License Number: | R0050272 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Administrator |
Taxonomy Definition: |