Provider Demographics
NPI:1366778474
Name:DAVIDSON, WAYUREEPORN (HIS)
Entity type:Individual
Prefix:MRS
First Name:WAYUREEPORN
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N DOUGLAS BLVD
Mailing Address - Street 2:STE. H
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3329
Mailing Address - Country:US
Mailing Address - Phone:405-732-9414
Mailing Address - Fax:405-732-9298
Practice Address - Street 1:101 N DOUGLAS BLVD
Practice Address - Street 2:STE. H
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3329
Practice Address - Country:US
Practice Address - Phone:405-732-9414
Practice Address - Fax:405-732-9298
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK982237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist