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General NPI Number Information
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NPI Number | 1558751628
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Entity Type | Individual
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Provider Name | HEATHER ELIZABETH HASENMYER PA
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Gender | Female
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 400 OAK STREET
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City | TAFT
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State | OK
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Zip | 74463-0315
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Country | US
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Telephone | 918-683-8365
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Fax | 918-686-7201
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Provider Business Mailing Address
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Address Line | 400 OAK STREET
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City | TAFT
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State | OK
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Zip | 74463-0315
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Country | US
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Telephone | 918-683-8365
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Fax | 918-686-7201
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2429
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License Number State | OK
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