Healthcare Provider Details

I. General information

NPI: 1487213302
Provider Name (Legal Business Name): RACHEL DIANE WRANY APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 12TH AVE NW
ARDMORE OK
73401-1283
US

IV. Provider business mailing address

701 CEDAR LAKE BLVD STE 120
OKLAHOMA CITY OK
73114-7806
US

V. Phone/Fax

Practice location:
  • Phone: 580-798-0234
  • Fax: 580-798-0319
Mailing address:
  • Phone: 405-445-1210
  • Fax: 405-445-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102278
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: