Healthcare Provider Details

I. General information

NPI: 1881171536
Provider Name (Legal Business Name): DAVID DELOERA RN MSN, AACNS-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 NW 130TH ST
OKLAHOMA CITY OK
73142-6003
US

IV. Provider business mailing address

3366 NW EXPRESSWAY STE 550
OKLAHOMA CITY OK
73112-4489
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-6928
  • Fax:
Mailing address:
  • Phone: 405-408-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number99089
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: