Individual
MRS. GRETCHEN MICHELLE BEAGLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCP LP
Contact information
Practice address
3601 N MAY AVE, SUITE C, OKLAHOMA CITY, OK 73112-6641
(405) 604-5613
(405) 601-3750
Mailing address
PO BOX 12815, OKLAHOMA CITY, OK 73157-2815
(405) 604-5613
(405) 601-3750
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
LP63
OK
247200000X
Other Technician
LP63
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5993501
AETNA
—
01
—
731522080002
BCBS
—
Enumeration date
12/26/2006
Last updated
03/29/2011
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