Healthcare Provider Details

I. General information

NPI: 1720614704
Provider Name (Legal Business Name): HALLI J ELDER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 W I 35 FRONTAGE RD STE 170
EDMOND OK
73013-8558
US

IV. Provider business mailing address

2017 W I 35 FRONTAGE RD STE 170
EDMOND OK
73013-8558
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-3742
  • Fax: 405-757-3744
Mailing address:
  • Phone: 405-757-3742
  • Fax: 405-757-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number106246
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0106246
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: