MEDICARE: CARRIE ANN VANHOOSE RN

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	163WP0200X	Pediatric Registered Nurse	R0117242	OK
2	363LF0000X	Family Nurse Practitioner	207009	OK

General Provider Information

NPI Number	:	1245985662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE ANN VANHOOSE RN

Provider Business Mailing Address
First Line	:	14424 N MAY AVE STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-5155
Country	:	US
Telephone Number	:	405-757-7818
Fax Number	:

Provider Business Practice Location Address
First Line	:	14424 N MAY AVE STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-5155
Country	:	US
Telephone Number	:	405-757-7818
Fax Number	:

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

Provider Enumeration Date	:	02/14/2022
Last Update Date	:	02/18/2022

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