=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205446770
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH NELL EUBANKS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2020
-----------------------------------------------------
Last Update Date | 08/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1418 W HICKORY ST
-----------------------------------------------------
City | STILWELL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74960-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 191-879-7778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 465280 E 810 RD
-----------------------------------------------------
City | STILWELL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74960-4439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-575-0287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------