Provider Demographics
NPI:1003192303
Name:WHITE OWL, CHERI LYNN (CRSS)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:WHITE OWL
Suffix:
Gender:F
Credentials:CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 N HIGHWAY 74C
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3260
Mailing Address - Country:US
Mailing Address - Phone:405-315-2928
Mailing Address - Fax:
Practice Address - Street 1:6320 N HIGHWAY 74C
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3260
Practice Address - Country:US
Practice Address - Phone:405-315-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK07161011171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator