Provider Demographics
NPI:1629435458
Name:FAIN, DALAYNA DIANE
Entity Type:Individual
Prefix:
First Name:DALAYNA
Middle Name:DIANE
Last Name:FAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 BROADWAY EXT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7408
Mailing Address - Country:US
Mailing Address - Phone:580-478-3027
Mailing Address - Fax:
Practice Address - Street 1:14025 N EASTERN AVE
Practice Address - Street 2:APT 3116
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5588
Practice Address - Country:US
Practice Address - Phone:580-478-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10052255A2300X
OK692390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer