Provider Demographics
NPI:1316241623
Name:WEASELBEAR, DOROTHY YVONNE (LPN)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:YVONNE
Last Name:WEASELBEAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 E CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5304
Mailing Address - Country:US
Mailing Address - Phone:580-331-3300
Mailing Address - Fax:
Practice Address - Street 1:522 E CLARK AVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5304
Practice Address - Country:US
Practice Address - Phone:580-331-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL 0053874164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse