Individual
MIRABEL FORTEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1301 W 6TH AVE STE 207, STILLWATER, OK 74074-4381
(405) 533-3010
Mailing address
1921 N SKYLINE ST, STILLWATER, OK 74075-3102
(405) 533-3010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
100187
OK
Other
Enumeration date
11/10/2016
Last updated
12/30/2016
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