Healthcare Provider Details

I. General information

NPI: 1174823678
Provider Name (Legal Business Name): PAULA LOUIES HANCOCK RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2010
Last Update Date: 10/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 LEIGH ST
DUNCAN OK
73533-1351
US

IV. Provider business mailing address

2610 LEIGH ST
DUNCAN OK
73533-1351
US

V. Phone/Fax

Practice location:
  • Phone: 580-736-4158
  • Fax: 580-606-6111
Mailing address:
  • Phone: 580-736-4158
  • Fax: 580-606-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number57881
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: