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General NPI Number Information
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NPI Number | 1073992889
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PAIN MANAGEMENT OF OKLAHOMA, P.L.L.C.
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 432 S MUSTANG RD STE A
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City | YUKON
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State | OK
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Zip | 73099-7312
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Country | US
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Telephone | 405-467-4399
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Fax | 405-467-4481
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Provider Business Mailing Address
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Address Line | 432 S MUSTANG RD STE A
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City | YUKON
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State | OK
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Zip | 73099-7312
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Country | US
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Telephone | 405-467-4399
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Fax | 405-467-4481
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBORAH NILSON
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Credential | DO
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Telephone | 405-568-2593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 4373
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License Number State | OK
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