# OLD TYME HOME VISITS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659748556
- **Authorized official:** DIANE DEWBRE ARNP-CNP (ADVANCED PRACTICE NURSE / OWNER)
- **Authorized official phone:** (405) 527-4704

## Contact information

- **Practice address:** 128 W MAIN ST, PURCELL, OK 73080-4220
- **Practice address phone:** (405) 527-4704
- **Practice address fax:** (405) 527-5976
- **Mailing address:** 128 W MAIN ST, PURCELL, OK 73080-4220
- **Mailing address phone:** (405) 527-4704
- **Mailing address fax:** (405) 527-5976

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | 49456 | OK | Yes |

## Other

- **Enumeration date:** 08/26/2015
- **Last updated:** 08/26/2015