Provider Demographics
NPI:1861797847
Name:DAUGHERTY, DANA HELEN (LM, CPM)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:HELEN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 S 90TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4421
Mailing Address - Country:US
Mailing Address - Phone:918-557-1247
Mailing Address - Fax:
Practice Address - Street 1:8835 S 90TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4421
Practice Address - Country:US
Practice Address - Phone:918-557-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99115176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife