1811987712 NPI number — DAWN M LOVINS DO

Table of content: DAWN M LOVINS DO (NPI 1811987712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811987712 NPI number — DAWN M LOVINS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVINS
Provider First Name:
DAWN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIVINGSTON
Provider Other First Name:
DAWN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811987712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1813 E MONTGOMERY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-804-6180
Provider Business Mailing Address Fax Number:
918-872-7984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N BAILEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRYOR
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74361-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-824-6324
Provider Business Practice Location Address Fax Number:
918-824-1603
Provider Enumeration Date:
10/24/2005

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: 207PE0004X , with the licence number:  4208 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200034490A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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