Provider Demographics
NPI:1467899724
Name:MAUDIE, SUKCHA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUKCHA
Middle Name:
Last Name:MAUDIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3408
Mailing Address - Country:US
Mailing Address - Phone:405-473-6153
Mailing Address - Fax:405-524-1677
Practice Address - Street 1:215 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3408
Practice Address - Country:US
Practice Address - Phone:405-473-6153
Practice Address - Fax:405-524-1677
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0074117363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health