Healthcare Provider Details

I. General information

NPI: 1508142357
Provider Name (Legal Business Name): PATRICIA A HARTSELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 N WASHINGTON AVE
DURANT OK
74701-2128
US

IV. Provider business mailing address

1604 N WASHINGTON AVE
DURANT OK
74701-2128
US

V. Phone/Fax

Practice location:
  • Phone: 580-920-0909
  • Fax: 580-931-3119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR74325
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: