Provider Demographics
NPI:1497742266
Name:BONSTEEL, CHARLOTTE ANNE (PA)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANNE
Last Name:BONSTEEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:ANNE
Other - Last Name:HIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 NW 85TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:405-608-3800
Mailing Address - Fax:405-608-3838
Practice Address - Street 1:4050 W MEMORIAL RD
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3800
Practice Address - Fax:405-608-3838
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100713380CMedicaid
OK100713380CMedicaid
OKOKA100689Medicare PIN
OKS18781Medicare UPIN
OKPA007021Medicare ID - Type Unspecified