1295052967 NPI number — MRS. DAWN RACHAE MILLARD BA, BHRS

Table of content: MRS. DAWN RACHAE MILLARD BA, BHRS (NPI 1295052967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295052967 NPI number — MRS. DAWN RACHAE MILLARD BA, BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLARD
Provider First Name:
DAWN
Provider Middle Name:
RACHAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BA, BHRS
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:
1295052967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 CARRIE LN NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIEDMONT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73078-9570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-226-7187
Provider Business Mailing Address Fax Number:
405-373-4910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 CARRIE LN NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIEDMONT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73078-9570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-226-7187
Provider Business Practice Location Address Fax Number:
405-373-4910
Provider Enumeration Date:
04/21/2010

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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