Healthcare Provider Details

I. General information

NPI: 1710733266
Provider Name (Legal Business Name): MICHELLE LADONNE HOHIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N 4TH ST
STILWELL OK
74960-2417
US

IV. Provider business mailing address

611 N 4TH ST
STILWELL OK
74960-2417
US

V. Phone/Fax

Practice location:
  • Phone: 918-696-6212
  • Fax: 918-696-6213
Mailing address:
  • Phone: 918-696-6212
  • Fax: 918-696-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: