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Lista Marie Dallis
Family Nurse Practitioner in Tahlequah, Oklahoma
NPI 1104468610

Lista Marie Dallis is a Family Nurse Practitioner based in Hulbert, OK and is specialized in Family. Lista Marie Dallis practices in Tahlequah, OK. The NPI Number for Lista Marie Dallis is 1104468610 and holds a License No. 99753 (Oklahoma).

The current practice location address for Lista Marie Dallis is 1500 E Downing St Ste 214, Tahlequah, OK and can be reached out via phone at 918-413-0202 and via fax at 918-431-0203.

Location: 1500 E Downing St Ste 214, Tahlequah, OK, 74441-0751
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1104468610
Provider Name
Lista Marie Dallis
Credential
Provider Entity Type
Individual
Gender
Female
Address
1500 E Downing St Ste 214, Tahlequah, OK, 74441-0751
Phone Number
918-413-0202
Fax Number
918-431-0203
Provider Enumeration Date
10/16/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1500 E Downing St Ste 214
City
Tahlequah
State
Oklahoma
Zip
74464-3379
Phone Number
918-413-0202
Fax Number
918-431-0203
person
Provider Business Mailing Address Details
Address
1500 E Downing St Ste 214
City
Tahlequah
State
Oklahoma
Zip
74464-3379
Phone Number
918-413-0202
Fax Number
918-431-0203
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
99753 (Oklahoma)
Definition
Definition to come...
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