Provider Demographics
NPI:1407521453
Name:RENFRO, DONNA GAYLE
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:GAYLE
Last Name:RENFRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BANNER AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5448
Mailing Address - Country:US
Mailing Address - Phone:405-510-4100
Mailing Address - Fax:
Practice Address - Street 1:501 W 15TH ST APT 77
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3647
Practice Address - Country:US
Practice Address - Phone:405-906-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3747A0650XOtherTAXONOMY