Provider Demographics
NPI:1639988991
Name:VANCLEEF, TRICIA
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:VANCLEEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15629 FOUNTAIN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2165
Mailing Address - Country:US
Mailing Address - Phone:956-293-0682
Mailing Address - Fax:
Practice Address - Street 1:15629 FOUNTAIN CREEK LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2165
Practice Address - Country:US
Practice Address - Phone:956-293-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0113625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse