Provider Demographics
NPI:1982067963
Name:LIBERTY SCHOOL
Entity type:Organization
Organization Name:LIBERTY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-427-3808
Mailing Address - Street 1:476490 E 1060 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-5159
Mailing Address - Country:US
Mailing Address - Phone:918-427-3808
Mailing Address - Fax:918-427-4961
Practice Address - Street 1:476490 E 1060 RD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-5159
Practice Address - Country:US
Practice Address - Phone:918-427-3808
Practice Address - Fax:918-427-4961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherFEDERAL EMPLOYER ID