Healthcare Provider Details

I. General information

NPI: 1699007492
Provider Name (Legal Business Name): NICHOLE DIANE PEOPLES RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S. FIFTH STREET
ENID OK
73701-5832
US

IV. Provider business mailing address

305 S. FIFTH STREET
ENID OK
73701-5832
US

V. Phone/Fax

Practice location:
  • Phone: 580-249-3437
  • Fax: 580-249-5857
Mailing address:
  • Phone: 580-249-3437
  • Fax: 580-249-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number75174
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: