Provider Demographics
NPI:1477010056
Name:STENMARK, THERESA DIANNE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DIANNE
Last Name:STENMARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 WICKFORD PL
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8390
Mailing Address - Country:US
Mailing Address - Phone:919-480-7303
Mailing Address - Fax:
Practice Address - Street 1:7410 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-6908
Practice Address - Country:US
Practice Address - Phone:405-680-4075
Practice Address - Fax:405-680-4095
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR80656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily