Individual
MRS. CAROLYN DIANNE DECLOUD-ATANASOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3524 NW 56TH ST, OKLAHOMA CITY, OK 73112-4518
(405) 606-6937
Mailing address
18009 CALDER RD, EDMOND, OK 73012-0041
(405) 535-3346
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0135602
OK
Other
Enumeration date
06/25/2022
Last updated
06/25/2022
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