| Organization Name: | OLD TYME HOME VISITS LLC |
| NPI Number: | 1659748556 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE DEWBRE (ADVANCED PRACTICE NURSE / OWNER) |
| Mailing Address: | 128 W Main St Purcell |
| State: | OK US |
| Postal Code: | 730804220 |
| Phone Number: | 4055274704 |
| Fax Number: | 4055275976 |
| NPI Enumeration Date: | 08/26/2015 |
| NPI Last Update Date: | 08/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 49456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |