Provider Demographics
NPI:1467967349
Name:KALIISA, HARRIET (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HARRIET
Middle Name:
Last Name:KALIISA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3922
Mailing Address - Country:US
Mailing Address - Phone:918-829-1721
Mailing Address - Fax:918-578-0082
Practice Address - Street 1:1831 E 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3922
Practice Address - Country:US
Practice Address - Phone:918-829-1721
Practice Address - Fax:918-578-0082
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC8072163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHC8072OtherLPN
OK474886124OtherSTATE LICENSE