Healthcare Provider Details

I. General information

NPI: 1407435894
Provider Name (Legal Business Name): FAN LI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/16/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST STE LL
TULSA OK
74135-5013
US

IV. Provider business mailing address

5310 E 31ST ST STE LL
TULSA OK
74135-5013
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: