Provider Demographics
NPI:1598779266
Name:DANTZLER, NANCY ANNE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANNE
Last Name:DANTZLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 STRAKA TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2544
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:405-604-0708
Practice Address - Street 1:106 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:OK
Practice Address - Zip Code:73570
Practice Address - Country:US
Practice Address - Phone:580-667-4149
Practice Address - Fax:580-667-4166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0048099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051130AMedicaid
OK200051130AMedicaid