Provider Demographics
NPI:1134590771
Name:CLABORN, WILLIAM (RN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CLABORN
Suffix:
Gender:M
Credentials:RN
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 550
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-0550
Mailing Address - Country:US
Mailing Address - Phone:918-427-3316
Mailing Address - Fax:918-427-1033
Practice Address - Street 1:715 W SHAWNTEL SMITH BLVD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-4013
Practice Address - Country:US
Practice Address - Phone:918-427-3316
Practice Address - Fax:918-427-1033
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0071361163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool