Provider Demographics
NPI:1275938797
Name:LITTERAL, RUBI ANN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:RUBI
Middle Name:ANN
Last Name:LITTERAL
Suffix:
Gender:F
Credentials:APRN-CNP
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 1009
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-1009
Mailing Address - Country:US
Mailing Address - Phone:580-225-5403
Mailing Address - Fax:580-225-5423
Practice Address - Street 1:411 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5201
Practice Address - Country:US
Practice Address - Phone:580-303-9293
Practice Address - Fax:580-540-3017
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200566660AMedicaid