Individual
MRS. MARY GRACE DIFUNTORUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, FNP
Contact information
Practice address
400 N EASTERN AVE, MOORE, OK 73160-5833
(405) 730-6990
(405) 730-6992
Mailing address
PO BOX 891625, OKLAHOMA CITY, OK 73189-1625
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
210920
OK
Other
Enumeration date
02/14/2023
Last updated
02/20/2026
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