Provider Demographics
NPI:1932384070
Name:SMITH, TINA WEBER (RNC, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:WEBER
Last Name:SMITH
Suffix:
Gender:F
Credentials:RNC, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4336 S DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1524
Mailing Address - Country:US
Mailing Address - Phone:918-451-0355
Mailing Address - Fax:918-494-3277
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-494-2270
Practice Address - Fax:918-494-3277
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist