Healthcare Provider Details

I. General information

NPI: 1346803681
Provider Name (Legal Business Name): REGAL DORN NEUROMONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S BALTIMORE AVE
TULSA OK
74119-4807
US

IV. Provider business mailing address

PO BOX 268953
OKLAHOMA CITY OK
73126-8953
US

V. Phone/Fax

Practice location:
  • Phone: 918-895-7680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: VALERIE SHEHAN
Title or Position: BILLING ASSOCIATE
Credential:
Phone: 918-895-7680