Provider Demographics
NPI:1750694345
Name:AIETAH STEPHENS
Entity type:Organization
Organization Name:AIETAH STEPHENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIETAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:405-684-8837
Mailing Address - Street 1:5001 KATELYN LANE
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064
Mailing Address - Country:US
Mailing Address - Phone:405-684-8837
Mailing Address - Fax:
Practice Address - Street 1:5001 KATELYN
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-7249
Practice Address - Country:US
Practice Address - Phone:405-684-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK592515332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies