Provider Demographics
NPI:1407805245
Name:ROUSE, ELIZABETH LOUISE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:ROUSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6520 E RENO AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-2119
Mailing Address - Country:US
Mailing Address - Phone:405-733-0120
Mailing Address - Fax:405-733-7877
Practice Address - Street 1:6520 E RENO AVE
Practice Address - Street 2:STE B
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110
Practice Address - Country:US
Practice Address - Phone:405-733-0120
Practice Address - Fax:405-733-7877
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01060207Q00000X
OK95370363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200264120AMedicaid
AR129607758Medicaid
OK1144307554OtherGROUP NPI
AR1649201286OtherGROUP NPI
OKBC5T024OtherBLUE CROSS
ARR97301Medicare UPIN
OK5C970Medicare PIN
OK200264120AMedicaid
AR1649201286OtherGROUP NPI