Provider Demographics
NPI:1831535632
Name:TUDER, ALANA SUE (MED)
Entity type:Individual
Prefix:MS
First Name:ALANA
Middle Name:SUE
Last Name:TUDER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:EUCHA
Mailing Address - State:OK
Mailing Address - Zip Code:74342-3181
Mailing Address - Country:US
Mailing Address - Phone:918-443-0037
Mailing Address - Fax:
Practice Address - Street 1:6330 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:EUCHA
Practice Address - State:OK
Practice Address - Zip Code:74342-3181
Practice Address - Country:US
Practice Address - Phone:918-443-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK166545L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist