Provider Demographics
NPI:1477328581
Name:BURTON-GAYNAIR, ROSE ELMERLEE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ELMERLEE
Last Name:BURTON-GAYNAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:ELMERLEE
Other - Last Name:BURTON-BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 NW 16TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6877
Mailing Address - Country:US
Mailing Address - Phone:912-332-0455
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 16TH ST APT 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6877
Practice Address - Country:US
Practice Address - Phone:912-332-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist