Healthcare Provider Details

I. General information

NPI: 1336887066
Provider Name (Legal Business Name): ERIN PRATER-BLOUNT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAPWING RD
EDMOND OK
73003-4829
US

IV. Provider business mailing address

801 W 33RD ST # 8282
EDMOND OK
73013-3811
US

V. Phone/Fax

Practice location:
  • Phone: 405-850-4143
  • Fax:
Mailing address:
  • Phone: 405-916-9972
  • Fax: 405-888-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR0113906
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: