Provider Demographics
NPI:1104239359
Name:NORRID, AMBER MICHELLE (CAC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:NORRID
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MICHELLE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7501 S 68TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3002
Mailing Address - Country:US
Mailing Address - Phone:918-695-5279
Mailing Address - Fax:
Practice Address - Street 1:7501 S 68TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3002
Practice Address - Country:US
Practice Address - Phone:918-695-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist