1447376223 NPI number — DR. STACY LYNN NOLAND D.O.

Table of content: DR. STACY LYNN NOLAND D.O. (NPI 1447376223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447376223 NPI number — DR. STACY LYNN NOLAND D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAND
Provider First Name:
STACY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
STACY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447376223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9001 S 101ST EAST AVE
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74133-5708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-293-6200
Provider Business Mailing Address Fax Number:
918-293-6246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9001 S 101ST EAST AVE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74133-5708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-293-6200
Provider Business Practice Location Address Fax Number:
918-293-6246
Provider Enumeration Date:
03/22/2007

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: 207V00000X , with the licence number:  4219 , 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: 1447376223 . This is a "NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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