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General NPI Number Information
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NPI Number | 1669785374
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Entity Type | Individual
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Provider Name | JUANITA GALE SLAIGHT REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 110916 S 4756 RD
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City | MULDROW
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State | OK
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Zip | 74948-5313
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Country | US
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Telephone | 479-739-0106
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Fax |
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Provider Business Mailing Address
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Address Line | 110916 S 4756 RD
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City | MULDROW
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State | OK
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Zip | 74948-5313
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Country | US
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Telephone | 479-739-0106
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R22646
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License Number State | AR
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