| Doctor Name: | JEANINE DIANNE DETERDING |
| NPI Number: | 1033117072 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | R0045604 |
| Business Practice Address: | 306 Fairview Ave Ponca City, OK - 746012001 |
| Business Phone Number: | 5807623342 |
| Business Fax Number: | 5807625841 |
| Mailing Address: | 306 Fairview Ave, PONCA CITY |
| State: | OK |
| Postal Code: | 746012001 |
| Phone Number: | 5807623342 |
| Fax Number: | 5807625841 |
| NPI Enumeration Date: | 07/13/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | R0045604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |