1154837763 NPI number — REBEKAH SANDERS APRN,FNP

Table of content: REBEKAH SANDERS APRN,FNP (NPI 1154837763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154837763 NPI number — REBEKAH SANDERS APRN,FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
REBEKAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN,FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154837763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 N 14TH ST STE 114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74601-1807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9003 N GARNETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWASSO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74055-4495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-272-2882
Provider Business Practice Location Address Fax Number:
918-928-4225
Provider Enumeration Date:
12/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  80142 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80142 . This is a "ADVANCED NURSING LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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