Provider Demographics
NPI:1255145686
Name:MISURACA, MCCAULEY
Entity type:Individual
Prefix:
First Name:MCCAULEY
Middle Name:
Last Name:MISURACA
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 1:11200 AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8378
Mailing Address - Country:US
Mailing Address - Phone:405-664-4485
Mailing Address - Fax:
Practice Address - Street 1:11200 AUTUMN RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8378
Practice Address - Country:US
Practice Address - Phone:405-664-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program