Provider Demographics
NPI:1861954984
Name:MOSIER, DONNA JEAN (RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:MOSIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1228 S HICKORY PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-3845
Mailing Address - Country:US
Mailing Address - Phone:405-301-6748
Mailing Address - Fax:
Practice Address - Street 1:715 W MAIN ST STE S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3553
Practice Address - Country:US
Practice Address - Phone:918-745-0501
Practice Address - Fax:918-747-9778
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96576163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200853440AMedicaid