Provider Demographics
NPI:1588479828
Name:CENTRAL OKLAHOMA DIABETES CENTER, PLLC
Entity type:Organization
Organization Name:CENTRAL OKLAHOMA DIABETES CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:405-801-4050
Mailing Address - Street 1:1912 HALLBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-3910
Mailing Address - Country:US
Mailing Address - Phone:405-412-8456
Mailing Address - Fax:405-561-4978
Practice Address - Street 1:2429 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6337
Practice Address - Country:US
Practice Address - Phone:405-801-4050
Practice Address - Fax:405-561-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care