Provider Demographics
NPI:1023821378
Name:LAGALY, ADAM (RN)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LAGALY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 S GLEN LN
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4138
Mailing Address - Country:US
Mailing Address - Phone:405-473-9069
Mailing Address - Fax:
Practice Address - Street 1:737 S GLEN LN
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4138
Practice Address - Country:US
Practice Address - Phone:405-473-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0116126163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency