1467731976 NPI number — AVIAN DINAH BREEDING LPN

Table of content: AVIAN DINAH BREEDING LPN (NPI 1467731976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467731976 NPI number — AVIAN DINAH BREEDING LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREEDING
Provider First Name:
AVIAN
Provider Middle Name:
DINAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
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:
1467731976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2804 EDGEMERE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-410-2367
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4149 HIGHLINE BLVD
Provider Second Line Business Practice Location Address:
SUITE 380
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73108-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-942-7650
Provider Business Practice Location Address Fax Number:
405-942-7686
Provider Enumeration Date:
08/15/2011

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: 164W00000X , with the licence number:  0059297 , 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: 200049040 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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