=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134135411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH NILSON D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 07/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 432 S MUSTANG ROAD STE A
-----------------------------------------------------
City | YUKON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73099-7312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-467-4399
-----------------------------------------------------
Fax | 405-467-4487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 432 S MUSTANG ROAD STE A
-----------------------------------------------------
City | YUKON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73099-7312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-467-4399
-----------------------------------------------------
Fax | 405-467-4487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 4373
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------