Provider Demographics
NPI:1114169786
Name:BACK, MARGARET (RN, IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:BACK
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 NW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7109
Mailing Address - Country:US
Mailing Address - Phone:405-848-5055
Mailing Address - Fax:
Practice Address - Street 1:2520 NW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7109
Practice Address - Country:US
Practice Address - Phone:405-848-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist