Healthcare Provider Details

I. General information

NPI: 1578913430
Provider Name (Legal Business Name): DONNA DURANT-MACON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SOUTH UTICA
TULSA OK
74104
US

IV. Provider business mailing address

315 S UTICA AVE
TULSA OK
74104-2203
US

V. Phone/Fax

Practice location:
  • Phone: 918-595-4167
  • Fax:
Mailing address:
  • Phone: 918-595-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0035629
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: