Provider Demographics
NPI:1497066054
Name:REDWINE, SARAH ANN (MED)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:REDWINE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:REDWINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:400 S CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6032
Mailing Address - Country:US
Mailing Address - Phone:405-364-5551
Mailing Address - Fax:405-364-9591
Practice Address - Street 1:400 S CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6032
Practice Address - Country:US
Practice Address - Phone:405-364-5551
Practice Address - Fax:405-364-9591
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional