Provider Demographics
NPI:1306933726
Name:LANA G NELSON DO PC
Entity type:Organization
Organization Name:LANA G NELSON DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-735-2049
Mailing Address - Street 1:PO BOX 721675
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8281
Mailing Address - Country:US
Mailing Address - Phone:405-735-2049
Mailing Address - Fax:405-563-9467
Practice Address - Street 1:520 S TELEPHONE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5424
Practice Address - Country:US
Practice Address - Phone:405-735-2049
Practice Address - Fax:405-563-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4264208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20074780AMedicaid
OK20074780AMedicaid
OKI43124Medicare UPIN
OK246715601Medicare PIN
OK400032Medicare PIN