Provider Demographics
NPI:1124017454
Name:STARR, MARY CONSTANCE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CONSTANCE
Last Name:STARR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 S PEORIA AVE
Mailing Address - Street 2:PPAEO INC
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7857
Mailing Address - Country:US
Mailing Address - Phone:918-858-5200
Mailing Address - Fax:918-582-4921
Practice Address - Street 1:818 S ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4803
Practice Address - Country:US
Practice Address - Phone:918-258-2952
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0021498363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health