Basic Information
| Provider Information | |||||||||
| NPI: | 1639110372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODELL | ||||||||
| FirstName: | RODANTHEE | ||||||||
| MiddleName: | BANJA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN-CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 STANTON L YOUNG BLVD STE 5400 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188102095 | ||||||||
| FaxNumber: | 4052712619 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 NE 10TH ST | ||||||||
| Address2: | SUITE 2F | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052718001 | ||||||||
| FaxNumber: | 4052715145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | R0075102 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 364SA2200X | R00075102 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.