Healthcare Provider Details

I. General information

NPI: 1851508915
Provider Name (Legal Business Name): NINA LOU HALLUM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINA ROBISON HALLUM ARNP

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 SOUTH 9TH STREET
JAY OK
74346
US

IV. Provider business mailing address

9935 STATE HIGHWAY 28
EUCHA OK
74342-4033
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-4511
  • Fax: 918-253-8419
Mailing address:
  • Phone: 918-253-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0046086
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: