Individual
AVIAN DINAH BREEDING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4149 HIGHLINE BLVD, SUITE 380, OKLAHOMA CITY, OK 73108-2103
(405) 942-7650
(405) 942-7686
Mailing address
2804 EDGEMERE DR, NORMAN, OK 73071
(405) 410-2367
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0059297
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049040
—
OK
Enumeration date
08/15/2011
Last updated
08/15/2011
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