Provider Demographics
NPI:1033132964
Name:REDHAGE, PATRICIA J (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:REDHAGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1236
Mailing Address - Country:US
Mailing Address - Phone:918-653-3723
Mailing Address - Fax:918-653-2116
Practice Address - Street 1:704 HWY 270
Practice Address - Street 2:
Practice Address - City:HEAVENER
Practice Address - State:OK
Practice Address - Zip Code:74937-9406
Practice Address - Country:US
Practice Address - Phone:918-653-3723
Practice Address - Fax:918-653-2116
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0057489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q70531Medicare UPIN
Q70531Medicare UPIN
OK200090160BMedicaid
OK247623501Medicare PIN
P00351966Medicare PIN