Healthcare Provider Details

I. General information

NPI: 1306955141
Provider Name (Legal Business Name): RACHEL LYNNE WHITEHOUSE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W OAKLAND ST
BROKEN ARROW OK
74012-1656
US

IV. Provider business mailing address

705 W OAKLAND ST
BROKEN ARROW OK
74012-1656
US

V. Phone/Fax

Practice location:
  • Phone: 918-251-2666
  • Fax: 918-258-7790
Mailing address:
  • Phone: 918-251-2666
  • Fax: 918-258-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2983
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: