Healthcare Provider Details

I. General information

NPI: 1326582297
Provider Name (Legal Business Name): LANA HUSONG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LANA SIZER LPN

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 E MELTON DRIVE
JAY OK
74346
US

IV. Provider business mailing address

859 E MELTON DRIVE
JAY OK
74346
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-1700
  • Fax: 918-253-6822
Mailing address:
  • Phone: 918-253-1700
  • Fax: 918-253-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number41686
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: