Individual
MRS. MARY ANNE DERRICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
13631 NE TOWNLEY RD, ELGIN, OK 73538-3705
(580) 512-0746
(580) 250-0506
Mailing address
13631 NE TOWNLEY RD, ELGIN, OK 73538-3705
(580) 512-0746
(580) 250-0506
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
49043
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45113
OKLAHOMA STATE BUREAU OF NARCOTICS AND DANGEROUS DRUG CONTROL REGISTRATION NUMBE
OK
Enumeration date
09/20/2012
Last updated
03/08/2013
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