Healthcare Provider Details

I. General information

NPI: 1851717755
Provider Name (Legal Business Name): JULIE ANN DIONNE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 SOUTHWEST BLVD
TULSA OK
74107-2705
US

IV. Provider business mailing address

100 N HICKERSON DR
CLEVELAND OK
74020-4003
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1980
  • Fax:
Mailing address:
  • Phone: 918-582-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5731
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5731
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: