1467179838 NPI number — CHRISTINA MARIE ROBY DYRSSEN MA

Table of content: CHRISTINA MARIE ROBY DYRSSEN MA (NPI 1467179838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467179838 NPI number — CHRISTINA MARIE ROBY DYRSSEN MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYRSSEN
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE ROBY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467179838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6033 NW 63RD ST APT G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARR ACRES
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73132-7535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-431-7101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9212 N KELLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73131-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-242-5070
Provider Business Practice Location Address Fax Number:
405-242-5071
Provider Enumeration Date:
10/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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