Healthcare Provider Details

I. General information

NPI: 1235620717
Provider Name (Legal Business Name): NATHAN HUNTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 N 14TH ST
PONCA CITY OK
74601-1917
US

IV. Provider business mailing address

2010 N 14TH ST
PONCA CITY OK
74601-1917
US

V. Phone/Fax

Practice location:
  • Phone: 580-718-9991
  • Fax: 580-718-9993
Mailing address:
  • Phone: 580-718-9991
  • Fax: 580-718-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1731
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: