MEDICARE: REBEKAH J LABOUFF APRN, CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	102805	OK

General Provider Information

NPI Number	:	1144768821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH J LABOUFF APRN, CPNP-PC

Provider Business Mailing Address
First Line	:	6465 S YALE AVE STE 320
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7805
Country	:	US
Telephone Number	:	918-493-3300
Fax Number	:	918-493-3315

Provider Business Practice Location Address
First Line	:	6465 S YALE AVE STE 320
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7805
Country	:	US
Telephone Number	:	918-493-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	01/16/2019

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