Healthcare Provider Details

I. General information

NPI: 1184310591
Provider Name (Legal Business Name): LEAANNA DAWN ZIBELL APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27371 S 4410 RD
VINITA OK
74301-7953
US

IV. Provider business mailing address

4175 E 130TH ST N
SKIATOOK OK
74070-4333
US

V. Phone/Fax

Practice location:
  • Phone: 918-256-4800
  • Fax:
Mailing address:
  • Phone: 918-232-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number211927
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: