Individual
DIANE REAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
604 E GLENDALE ST, BROKEN ARROW, OK 74011-3597
(918) 850-2233
(877) 777-2249
Mailing address
604 E GLENDALE ST, BROKEN ARROW, OK 74011-3597
(918) 850-2233
(877) 777-2249
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
ROO49723
OK
163WP0808X
Psychiatric/Mental Health Registered Nurse
R0049723
OK
Other
Enumeration date
05/29/2013
Last updated
05/29/2013
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