Provider Demographics
NPI:1659910446
Name:HOLLEN BUBLITZ, RACHEL ALINE (APRN AG-CNS BC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALINE
Last Name:HOLLEN BUBLITZ
Suffix:
Gender:F
Credentials:APRN AG-CNS BC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ALINE
Other - Last Name:HOLLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN AG-CNS BC
Mailing Address - Street 1:8516 NW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2128
Mailing Address - Country:US
Mailing Address - Phone:417-818-5828
Mailing Address - Fax:
Practice Address - Street 1:700 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5004
Practice Address - Country:US
Practice Address - Phone:405-514-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122037364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist