Provider Demographics
NPI:1669785374
Name:SLAIGHT, JUANITA GALE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:GALE
Last Name:SLAIGHT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110916 S 4756 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-5313
Mailing Address - Country:US
Mailing Address - Phone:479-739-0106
Mailing Address - Fax:
Practice Address - Street 1:110916 S 4756 RD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-5313
Practice Address - Country:US
Practice Address - Phone:479-739-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR22646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR22646OtherREGISTERED NURSE LICENSE