Provider Demographics
NPI:1184952798
Name:DEBORAH L. NILSON, DO PC
Entity type:Organization
Organization Name:DEBORAH L. NILSON, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-775-9350
Mailing Address - Street 1:PO BOX 108835
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8835
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:3855 S BOULEVARD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5498
Practice Address - Country:US
Practice Address - Phone:405-285-9789
Practice Address - Fax:405-285-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK43732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5857Medicare PIN