Provider Demographics
NPI:1225480510
Name:RI-IMAGINE HOLISTIC WOMEN'S HEALTH AND MIDWIFERY CARE PLLC
Entity Type:Organization
Organization Name:RI-IMAGINE HOLISTIC WOMEN'S HEALTH AND MIDWIFERY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:NETRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TEREF-TA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNM
Authorized Official - Phone:405-519-5519
Mailing Address - Street 1:2121 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6459
Mailing Address - Country:US
Mailing Address - Phone:405-519-5519
Mailing Address - Fax:
Practice Address - Street 1:2121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6459
Practice Address - Country:US
Practice Address - Phone:405-519-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0055332261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility