Healthcare Provider Details

I. General information

NPI: 1861797847
Provider Name (Legal Business Name): DANA HELEN DAUGHERTY LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 S 90TH EAST AVE
TULSA OK
74133-4421
US

IV. Provider business mailing address

8835 S 90TH EAST AVE
TULSA OK
74133-4421
US

V. Phone/Fax

Practice location:
  • Phone: 918-557-1247
  • Fax:
Mailing address:
  • Phone: 918-557-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: