Healthcare Provider Details

I. General information

NPI: 1255175279
Provider Name (Legal Business Name): DION L SALES MSN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MAIN ST
HENRYETTA OK
74437-4241
US

IV. Provider business mailing address

1431 S FLORENCE AVE
TULSA OK
74104-4808
US

V. Phone/Fax

Practice location:
  • Phone: 539-667-0001
  • Fax:
Mailing address:
  • Phone: 619-339-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR0116163
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: