Provider Demographics
NPI:1861019556
Name:PEOPLES, DORISSENIA ANNTIONETTE (AGNP)
Entity Type:Individual
Prefix:
First Name:DORISSENIA
Middle Name:ANNTIONETTE
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:DORISSENIA
Other - Middle Name:ANNTIONETTE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5817 NW 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2830
Mailing Address - Country:US
Mailing Address - Phone:405-317-0575
Mailing Address - Fax:
Practice Address - Street 1:5817 NW 90TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-2830
Practice Address - Country:US
Practice Address - Phone:405-317-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0079394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily