Healthcare Provider Details

I. General information

NPI: 1588840227
Provider Name (Legal Business Name): DIANE E. SHARP R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE E. WATTS

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 05/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

6921 E DANFORTH RD
EDMOND OK
73034-7602
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-3586
  • Fax: 405-936-5204
Mailing address:
  • Phone: 405-249-4351
  • Fax: 405-936-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0025941
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number194-12129
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: