Provider Demographics
NPI:1154825206
Name:DOBBS, DANEAL CHANDEL (ARNP)
Entity Type:Individual
Prefix:
First Name:DANEAL
Middle Name:CHANDEL
Last Name:DOBBS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DANEAL
Other - Middle Name:C
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10196C W PERRY RD
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2643
Mailing Address - Country:US
Mailing Address - Phone:918-694-2396
Mailing Address - Fax:918-421-6963
Practice Address - Street 1:3 E CLARK BASS BLVD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4283
Practice Address - Country:US
Practice Address - Phone:918-421-6960
Practice Address - Fax:918-421-6963
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78163363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner