Provider Demographics
NPI:1891891768
Name:PRETTY WATER SCHOOL
Entity Type:Organization
Organization Name:PRETTY WATER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCILE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-224-4952
Mailing Address - Street 1:15223 W 81ST ST S
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-2984
Mailing Address - Country:US
Mailing Address - Phone:918-224-4952
Mailing Address - Fax:918-224-4039
Practice Address - Street 1:15223 W 81ST ST S
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2984
Practice Address - Country:US
Practice Address - Phone:918-224-4952
Practice Address - Fax:918-224-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0042052251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care