Provider Demographics
NPI:1407016306
Name:RORICK, MARY JANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:RORICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5403
Mailing Address - Country:US
Mailing Address - Phone:405-605-8280
Mailing Address - Fax:405-278-7831
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 660
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:405-951-4342
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05319363A00000X
OK1748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant