Provider Demographics
NPI:1760155675
Name:CROSS, DONNA (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SW 30TH CT STE A
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2887
Mailing Address - Country:US
Mailing Address - Phone:405-703-0937
Mailing Address - Fax:888-290-8567
Practice Address - Street 1:1109 SW 30TH CT STE A
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2887
Practice Address - Country:US
Practice Address - Phone:405-703-0937
Practice Address - Fax:888-290-8567
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK204369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily