Provider Demographics
NPI:1740797182
Name:PIONTEK, RAVEN JEANEENE (FNP-C, IBCLC)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:JEANEENE
Last Name:PIONTEK
Suffix:
Gender:F
Credentials:FNP-C, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-2839
Mailing Address - Country:US
Mailing Address - Phone:580-919-5363
Mailing Address - Fax:
Practice Address - Street 1:1202 NW ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-6537
Practice Address - Country:US
Practice Address - Phone:580-248-2288
Practice Address - Fax:580-248-5757
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-133766163WL0100X
OK106583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant