Provider Demographics
NPI:1316476153
Name:POLAND, DESIRA
Entity type:Individual
Prefix:
First Name:DESIRA
Middle Name:
Last Name:POLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESIRA
Other - Middle Name:
Other - Last Name:CRONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 W BIXBY ST
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4713
Mailing Address - Country:US
Mailing Address - Phone:918-982-4955
Mailing Address - Fax:
Practice Address - Street 1:12005 E 470 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3737
Practice Address - Country:US
Practice Address - Phone:918-342-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator