Provider Demographics
NPI:1659627073
Name:ALLTIZER, MARY CHRISTINE (RN, BSN, MSM)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTINE
Last Name:ALLTIZER
Suffix:
Gender:F
Credentials:RN, BSN, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 YELLOWSTONE LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4675
Mailing Address - Country:US
Mailing Address - Phone:405-844-8894
Mailing Address - Fax:
Practice Address - Street 1:430 W WILSHIRE BLVD
Practice Address - Street 2:SUITES 9 & 10
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7771
Practice Address - Country:US
Practice Address - Phone:405-521-8635
Practice Address - Fax:405-521-8652
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0026787163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent