Provider Demographics
NPI:1639110372
Name:GOODELL, RODANTHEE BANJA (APRN-CNS)
Entity Type:Individual
Prefix:MRS
First Name:RODANTHEE
Middle Name:BANJA
Last Name:GOODELL
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 STANTON L YOUNG BLVD STE 5400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5018
Mailing Address - Country:US
Mailing Address - Phone:918-810-2095
Mailing Address - Fax:405-271-2619
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-8001
Practice Address - Fax:405-271-5145
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0075102364S00000X
OKR00075102364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist