Healthcare Provider Details

I. General information

NPI: 1851698963
Provider Name (Legal Business Name): DEBORA ANN RATZLAFF RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

7508 E 88TH PL
TULSA OK
74133-4841
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-6550
  • Fax:
Mailing address:
  • Phone: 918-284-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0039380
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11013108
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: