Basic Information
| Provider Information | |||||||||
| NPI: | 1972939122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORSEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RENHAE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1370 N INTERSTATE DR | ||||||||
| Address2: | SUITE 154 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730723376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052476685 | ||||||||
| FaxNumber: | 4052472043 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 E CENTRAL BLVD | ||||||||
| Address2: | |||||||||
| City: | ANADARKO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730054406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052476685 | ||||||||
| FaxNumber: | 4052472043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2013 | ||||||||
| LastUpdateDate: | 06/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 93355 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.