Provider Demographics
NPI:1053137034
Name:COMPOSURE SOLUTION LLC
Entity type:Organization
Organization Name:COMPOSURE SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:918-815-9443
Mailing Address - Street 1:9001 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-8547
Mailing Address - Country:US
Mailing Address - Phone:918-815-9443
Mailing Address - Fax:
Practice Address - Street 1:1 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-2752
Practice Address - Country:US
Practice Address - Phone:918-816-9443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPOSURE SOLUTION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty