Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | R0031310 | OK |
NPI | 1922215284 |
---|---|
Provider Name | Deborah Lea Farley |
First Address | Idabel, OK 74745-6858 |
Second Address | Idabel, OK 74745-6858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 09/07/2007 |