Basic Information
| Provider Information | |||||||||
| NPI: | 1023551611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WESLEY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27371 S 4410 RD | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743017953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182564836 | ||||||||
| FaxNumber: | 9182564589 | ||||||||
| Practice Location | |||||||||
| Address1: | 27371 S 4410 RD | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743017953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182564836 | ||||||||
| FaxNumber: | 9182564589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2016 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 0048847 | OK | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.