Provider Demographics
NPI:1578310124
Name:CERNOBYL, CRISTIE
Entity type:Individual
Prefix:
First Name:CRISTIE
Middle Name:
Last Name:CERNOBYL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448950 E 982 LOOP
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962-7001
Mailing Address - Country:US
Mailing Address - Phone:405-308-2200
Mailing Address - Fax:
Practice Address - Street 1:448950 E 982 LOOP
Practice Address - Street 2:
Practice Address - City:VIAN
Practice Address - State:OK
Practice Address - Zip Code:74962-7001
Practice Address - Country:US
Practice Address - Phone:405-308-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist