Provider Demographics
NPI:1720313901
Name:DIENNA, CHRISTINE G (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:G
Last Name:DIENNA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DI ENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3433 NW 56TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4430
Mailing Address - Country:US
Mailing Address - Phone:405-947-3341
Mailing Address - Fax:405-945-3197
Practice Address - Street 1:3433 NW 56TH ST STE 400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4430
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:405-945-3126
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5848207R00000X, 207RC0000X
IA4352207RC0000X
FLUO2253208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200617410AMedicaid