Healthcare Provider Details

I. General information

NPI: 1669690269
Provider Name (Legal Business Name): CHRISTINE RENEE HAUCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 GRANT BLVD
YUKON OK
73099
US

IV. Provider business mailing address

11200 LERIDA LN
OKLAHOMA CITY OK
73173-8158
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-4660
  • Fax: 405-470-3377
Mailing address:
  • Phone: 405-314-5266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number0079042
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number0079042
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79042
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: