MEDICARE: LISA RENEE DAUTENHAHN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R0042544	OK

General Provider Information

NPI Number	:	1104894658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENEE DAUTENHAHN ARNP

Provider Business Mailing Address
First Line	:	6600 S YALE AVE
Second Line	:	SUITE 1400
City	:	TULSA
State	:	OK
Zip	:	74136-3310
Country	:	US
Telephone Number	:	918-488-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 E 91ST ST
Second Line	:	SUITE 110
City	:	TULSA
State	:	OK
Zip	:	74133-5801
Country	:	US
Telephone Number	:	918-307-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	03/04/2010

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