Healthcare Provider Details

I. General information

NPI: 1548329832
Provider Name (Legal Business Name): JOANNE DOROTHEA CRAIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE OLSON

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E GARRIOTT
ENID OK
73701
US

IV. Provider business mailing address

2816 MEADOWLARK
ENID OK
73703
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-8315
  • Fax: 580-233-9441
Mailing address:
  • Phone: 580-242-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR0031005
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: