Provider Demographics
NPI:1013254622
Name:GOTES, LOIS L (NP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:L
Last Name:GOTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4409
Mailing Address - Country:US
Mailing Address - Phone:918-647-2929
Mailing Address - Fax:918-647-2288
Practice Address - Street 1:1013 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4409
Practice Address - Country:US
Practice Address - Phone:918-647-2929
Practice Address - Fax:918-647-2288
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR57845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner