Active NPI
Roberta Dehaas
- Licensed Practical Nurse
- Enid, OK
National Provider Identifier
1811210354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 33653
- Practice address
- 702 N Grand St
Enid, OK 73701-3221 - Phone
- (580) 234-3791
- Fax
- (580) 237-7711
- NPI assigned
- Mar 11, 2010
- Last updated
- Mar 11, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 33653 | OK | Primary |
Addresses
Primary practice location
702 N Grand St
Enid, OK 73701-3221
Mailing address
1222 10TH St
Suite 211
Woodward, OK 73801-3156
Phone (580) 234-3791
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268265600000",
"number": "1811210354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1222 10TH ST",
"address_2": "SUITE 211",
"city": "WOODWARD",
"state": "OK",
"postal_code": "738013156",
"telephone_number": "580-234-3791",
"fax_number": "580-237-7711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 N GRAND ST",
"city": "ENID",
"state": "OK",
"postal_code": "737013221",
"telephone_number": "580-234-3791",
"fax_number": "580-237-7711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEHAAS",
"first_name": "ROBERTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-11",
"last_updated": "2010-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OK",
"license": "33653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Enid, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.