Provider Demographics
NPI:1174590731
Name:MARANTO, MICHELE W (NURSE PRACTITIONER A)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:W
Last Name:MARANTO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SE 19TH
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6618
Mailing Address - Country:US
Mailing Address - Phone:405-348-6611
Mailing Address - Fax:405-348-9280
Practice Address - Street 1:1501 SE 19TH
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6618
Practice Address - Country:US
Practice Address - Phone:405-348-6611
Practice Address - Fax:405-348-9280
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR63497363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248405901Medicare ID - Type Unspecified
Q04526Medicare UPIN