Provider Demographics
NPI:1881171536
Name:DELOERA, DAVID (RN MSN, AACNS-AG)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DELOERA
Suffix:
Gender:M
Credentials:RN MSN, AACNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 NW EXPRESSWAY STE 550
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4489
Mailing Address - Country:US
Mailing Address - Phone:405-408-9770
Mailing Address - Fax:
Practice Address - Street 1:3366 NW EXPRESSWAY STE 550
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4489
Practice Address - Country:US
Practice Address - Phone:405-408-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99089163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK99089OtherSTATE OF OK RN LICENSE