Provider Demographics
NPI:1558784363
Name:FIELDS-HOGAN, TAMRA
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:FIELDS-HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TAMRA
Other - Middle Name:LADALE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN
Mailing Address - Street 1:1168 N DOUGLAS BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-1325
Mailing Address - Country:US
Mailing Address - Phone:405-618-4720
Mailing Address - Fax:
Practice Address - Street 1:3301 N MLK AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-4216
Practice Address - Country:US
Practice Address - Phone:405-548-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52749164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse