Healthcare Provider Details

I. General information

NPI: 1770628703
Provider Name (Legal Business Name): GLORIA JEAN BOND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST
NORMAN OK
73071-5305
US

IV. Provider business mailing address

PO BOX 433
BLANCHARD OK
73010-0433
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-6466
  • Fax:
Mailing address:
  • Phone: 405-485-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number33880
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: