Provider Demographics
NPI:1679521553
Name:NELSON, LANA GAIL (DO)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:GAIL
Last Name:NELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6630
Mailing Address - Fax:405-701-6170
Practice Address - Street 1:2821 36TH AVE NW STE 105
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2471
Practice Address - Country:US
Practice Address - Phone:405-515-2049
Practice Address - Fax:405-307-5631
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4264208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200074780AMedicaid
OK234529001Medicare PIN
OKI43124Medicare UPIN
OK246715601Medicare PIN