MEDICARE: ANTHONY LEE ROCKEFELLER R.N.

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	163WR0400X	Rehabilitation Registered Nurse	R0062167	OK

General Provider Information

NPI Number	:	1811961022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY LEE ROCKEFELLER R.N.

Provider Business Mailing Address
First Line	:	8523 E 11TH ST
Second Line	:	SUITE A2
City	:	TULSA
State	:	OK
Zip	:	74112-7963
Country	:	US
Telephone Number	:	918-836-9100
Fax Number	:	918-836-9106

Provider Business Practice Location Address
First Line	:	8523 E 11TH ST
Second Line	:	SUITE A2
City	:	TULSA
State	:	OK
Zip	:	74112-7963
Country	:	US
Telephone Number	:	918-836-9100
Fax Number	:	918-836-9106

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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