Basic Information
| Provider Information | |||||||||
| NPI: | 1750511861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELONG | ||||||||
| FirstName: | DOREEN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2210 DUNCAN REGIONAL LOOP | ||||||||
| Address2: | |||||||||
| City: | DUNCAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735331564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802516656 | ||||||||
| FaxNumber: | 5802516668 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 JACKIE RD | ||||||||
| Address2: | |||||||||
| City: | DUNCAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735331565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802518250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 47480 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.