Provider Demographics
NPI:1548329832
Name:CRAIN, JOANNE DOROTHEA (RN)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:DOROTHEA
Last Name:CRAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2816 MEADOWLARK
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-242-0618
Mailing Address - Fax:
Practice Address - Street 1:314 E GARRIOTT
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701
Practice Address - Country:US
Practice Address - Phone:580-223-8315
Practice Address - Fax:580-233-9441
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0031005163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice