LISTA MARIE DALLIS NPI 1104468610

NPI Information

NPI: 1104468610
Provider Name: LISTA MARIE DALLIS
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC

PECOS Registration: Yes

Address:
1500 E DOWNING ST STE 214
TAHLEQUAH, OK
ZIP 74464
Phone: (918) 413-0202
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Lista Marie Dallis is a family nurse practitioner in Tahlequah, OK with 5 years of experience. Lista Marie Dallis NPI is 1104468610. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1500 E DOWNING ST STE 214
TAHLEQUAH, OK
ZIP 74464-379
Phone: (918) 413-0202
Fax: (918) 431-0203

The NPI 1104468610 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/16/2019 and was last updated on 2/17/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	99753	OKLAHOMA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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