Doctor Name: | MRS. LAURA JEAN HALLACY |
NPI Number: | 1124011242 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | R0072294 |
Business Practice Address: | 36488 S Highway 82 Vinita, OK - 743017438 |
Business Phone Number: | 9187821881 |
Business Fax Number: | 9187824266 |
Mailing Address: | 453563 Lakeview Ter, AFTON |
State: | OK |
Postal Code: | 743318559 |
Phone Number: | 9187829360 |
Fax Number: | |
NPI Enumeration Date: | 08/24/2005 |
NPI Last Update Date: | 08/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R0072294 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |