Basic Information
| Provider Information | |||||||||
| NPI: | 1912035676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIETH | ||||||||
| FirstName: | DONNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 N MAY AVE | ||||||||
| Address2: | STE C | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731126641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056010954 | ||||||||
| FaxNumber: | 4056013750 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 S 5TH | ||||||||
| Address2: | ST. MARY'S HOSPITAL | ||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802336100 | ||||||||
| FaxNumber: | 5802493982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246X00000X | 60 | OK | Y | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Cardiovascular |
No ID Information.