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General NPI Number Information
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NPI Number | 1740797182
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Entity Type | Individual
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Provider Name | RAVEN JEANEENE PIONTEK FNP-C, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 1202 NW ARLINGTON AVE
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City | LAWTON
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State | OK
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Zip | 73507-6537
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Country | US
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Telephone | 580-248-2288
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Fax | 580-248-5757
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Provider Business Mailing Address
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Address Line | 619 E SOUTH BOUNDARY ST
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City | WALTERS
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State | OK
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Zip | 73572-2839
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Country | US
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Telephone | 580-919-5363
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-133766
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 106583
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License Number State | OK
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