=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063098283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE DAWN HASH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2021
-----------------------------------------------------
Last Update Date | 03/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31870 E STATE HIGHWAY 51
-----------------------------------------------------
City | COWETA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74429-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-279-3471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7209 S ELDER AVE
-----------------------------------------------------
City | BROKEN ARROW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74011-8293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-704-1226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | L0054702
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------