Healthcare Provider Details

I. General information

NPI: 1710871447
Provider Name (Legal Business Name): TAMARA DILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST
TULSA OK
74135-2536
US

IV. Provider business mailing address

4313 E 101ST PL
TULSA OK
74137-5932
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number219189
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: