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General NPI Number Information
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NPI Number | 1841056900
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Entity Type | Individual
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Provider Name | MS. TONYA RENEE' SUBLETT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 3401 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-6332
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Country | US
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Telephone | 580-355-8620
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Fax |
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Provider Business Mailing Address
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Address Line | 414 NW 57TH ST
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City | LAWTON
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State | OK
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Zip | 73505-5715
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Country | US
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Telephone | 580-917-7577
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 220017
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License Number State | OK
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