Provider Demographics
NPI:1154837763
Name:SANDERS, REBEKAH (APRN,FNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:APRN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N 14TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9003 N GARNETT RD
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4495
Practice Address - Country:US
Practice Address - Phone:918-272-2882
Practice Address - Fax:918-928-4225
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK80142OtherADVANCED NURSING LICENSE