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General NPI Number Information
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NPI Number | 1750694345
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Entity Type | Organization
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Legal Business Name | AIETAH STEPHENS
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 5001 KATELYN
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City | MUSTANG
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State | OK
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Zip | 73064-7249
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Country | US
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Telephone | 405-684-8837
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 KATELYN LANE
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City | MUSTANG
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State | OK
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Zip | 73064
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Country | US
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Telephone | 405-684-8837
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AIETAH LYNN STEPHENS
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Credential | MS
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Telephone | 405-684-8837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 592515
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License Number State | OK
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