Healthcare Provider Details

I. General information

NPI: 1083283329
Provider Name (Legal Business Name): NATHAN VERAL HOLLENBECK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. NATE VERAL HOLLENBECK

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S MADISON ST STE 209A
ENID OK
73701-7270
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-2300
  • Fax:
Mailing address:
  • Phone: 405-618-1586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0101409
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: