Provider Demographics
NPI:1780184754
Name:ROTHER, PAULA JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:ROTHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30754 DRAKE CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9208
Mailing Address - Country:US
Mailing Address - Phone:405-664-8549
Mailing Address - Fax:
Practice Address - Street 1:1111 N LEE AVE STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2620
Practice Address - Country:US
Practice Address - Phone:405-600-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77254363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health