Healthcare Provider Details

I. General information

NPI: 1225375595
Provider Name (Legal Business Name): DANA CLINE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9020
US

IV. Provider business mailing address

744 W 9TH ST
TULSA OK
74127-9020
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-5993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number79026
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: