Provider Demographics
NPI:1154030724
Name:LTCNP
Entity type:Organization
Organization Name:LTCNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:405-560-5561
Mailing Address - Street 1:14355 W CRESCENT DOVER RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:OK
Mailing Address - Zip Code:73028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:405-400-2559
Practice Address - Street 1:14355 W CRESCENT DOVER RD
Practice Address - Street 2:
Practice Address - City:CRESCENT
Practice Address - State:OK
Practice Address - Zip Code:73028
Practice Address - Country:US
Practice Address - Phone:405-650-5561
Practice Address - Fax:405-400-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care