Provider Demographics
NPI:1134634298
Name:PERRY, SANDRA PAULINE (CNM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:PAULINE
Last Name:PERRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30305 W COUNTY ROAD 1250
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-3470
Mailing Address - Country:US
Mailing Address - Phone:918-839-5349
Mailing Address - Fax:
Practice Address - Street 1:30305 W COUNTY ROAD 1250
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-3470
Practice Address - Country:US
Practice Address - Phone:918-839-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96190367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife