Provider Demographics
NPI:1962204271
Name:WHITEBUFFALO, DAISY
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:WHITEBUFFALO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 MEEKER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4215
Mailing Address - Country:US
Mailing Address - Phone:405-467-6918
Mailing Address - Fax:
Practice Address - Street 1:1950 S SHEPARD AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-6357
Practice Address - Country:US
Practice Address - Phone:405-766-9742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist