Basic Information
| Provider Information | |||||||||
| NPI: | 1386303006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHARIS | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | ALVA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737171769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807481512 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 604 CHOCTAW ST | ||||||||
| Address2: | |||||||||
| City: | ALVA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737171626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803271112 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2021 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | L0060310 | OK | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.