Healthcare Provider Details

I. General information

NPI: 1306933726
Provider Name (Legal Business Name): LANA G NELSON DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S TELEPHONE RD SUITE 101
MOORE OK
73160-5424
US

IV. Provider business mailing address

PO BOX 721675
NORMAN OK
73070-8281
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-2049
  • Fax: 405-563-9467
Mailing address:
  • Phone: 405-735-2049
  • Fax: 405-563-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4264
License Number StateOK

VIII. Authorized Official

Name: DR. LANA GAIL NELSON
Title or Position: PRESIDENT
Credential: DO
Phone: 405-735-2049