Provider Demographics
NPI:1811961022
Name:ROCKEFELLER, ANTHONY LEE (RN)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEE
Last Name:ROCKEFELLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 E 11TH ST
Mailing Address - Street 2:SUITE A2
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7963
Mailing Address - Country:US
Mailing Address - Phone:918-836-9100
Mailing Address - Fax:918-836-9106
Practice Address - Street 1:8523 E 11TH ST
Practice Address - Street 2:SUITE A2
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7963
Practice Address - Country:US
Practice Address - Phone:918-836-9100
Practice Address - Fax:918-836-9106
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062167163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation