Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 2983 | OK |
NPI | 1306955141 |
---|---|
Provider Name | Rachel Lynne Whitehouse |
First Address | Broken Arrow, OK 74012-1656 |
Second Address | Broken Arrow, OK 74012-1656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 01/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100089970A | (05) | OK |
E92811 | (02) | OK |