Provider Demographics
NPI:1114708534
Name:CHRISTIE, DEANNA LEE (BS RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LEE
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:BS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471192 E 781 RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3476
Mailing Address - Country:US
Mailing Address - Phone:918-575-2045
Mailing Address - Fax:
Practice Address - Street 1:1418 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3247
Practice Address - Country:US
Practice Address - Phone:918-575-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0058277163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty