Provider Demographics
NPI:1780230862
Name:VANDEVOIR, CAROL RENEE (PRSS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:RENEE
Last Name:VANDEVOIR
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2832
Mailing Address - Country:US
Mailing Address - Phone:405-233-9804
Mailing Address - Fax:
Practice Address - Street 1:3033 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2832
Practice Address - Country:US
Practice Address - Phone:405-233-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist