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General NPI Number Information
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NPI Number | 1124355805
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Entity Type | Individual
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Provider Name | PAULA HILDESTAD
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Gender | Female
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 7010 S YALE AVE STE 215
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City | TULSA
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State | OK
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Zip | 74136-5743
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Country | US
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Telephone | 918-492-2554
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Fax |
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Provider Business Mailing Address
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Address Line | 407 WILL ROGERS LOOP E
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City | OOLOGAH
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State | OK
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Zip | 74053-6211
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Country | US
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Telephone | 918-625-1458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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