Provider Demographics
NPI:1760787162
Name:ADAMS, RAE ANNETTE
Entity Type:Individual
Prefix:MRS
First Name:RAE
Middle Name:ANNETTE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAE
Other - Middle Name:ANNETTE
Other - Last Name:VALLANCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5107
Mailing Address - Country:US
Mailing Address - Phone:405-418-3821
Mailing Address - Fax:405-639-3077
Practice Address - Street 1:301 NW 63
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-418-3821
Practice Address - Fax:405-639-3077
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator