1629460340 NPI number — MRS. DONNA JO TIEMANN MAR

Table of content: MRS. DONNA JO TIEMANN MAR (NPI 1629460340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629460340 NPI number — MRS. DONNA JO TIEMANN MAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIEMANN
Provider First Name:
DONNA
Provider Middle Name:
JO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MAR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOMACK
Provider Other First Name:
DONNA
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629460340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2514 SW 58TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73119-5829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-651-2618
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2514 SW 58TH ST
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:
73119-5829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-651-2618
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2015

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: 171M00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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