Provider Demographics
NPI:1467780874
Name:ROLLINS, STEFANIE ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ELLEN
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:ELLEN
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5010
Mailing Address - Country:US
Mailing Address - Phone:405-235-0040
Mailing Address - Fax:405-272-4028
Practice Address - Street 1:750 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5010
Practice Address - Country:US
Practice Address - Phone:405-235-0040
Practice Address - Fax:405-272-4028
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200270100AMedicaid
OK200270100AMedicaid