Healthcare Provider Details

I. General information

NPI: 1427246008
Provider Name (Legal Business Name): DORSA DIANNE AHLEFELD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORSA SELF AHLEFELD ARNP

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE SUITE 7D
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

1200 CHILDRENS AVE SUITE 7D
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3800
  • Fax: 405-271-3399
Mailing address:
  • Phone: 405-271-3800
  • Fax: 405-271-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR0078915
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: