MEDICARE: STEPHANIE L VANHOOSER

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	363LA2100X	Acute Care Nurse Practitioner	67066	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	67066	OTHER	OK	OK LICENSE NUMBER

General Provider Information

NPI Number	:	1740749696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE L VANHOOSER

Provider Business Mailing Address
First Line	:	3433 NW 56TH ST STE 760
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4461
Country	:	US
Telephone Number	:	405-951-4345
Fax Number	:	405-951-4392

Provider Business Practice Location Address
First Line	:	3433 NW 56TH ST STE 760
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4461
Country	:	US
Telephone Number	:	405-951-4345
Fax Number	:	405-951-4392

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	03/19/2019

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