Provider Demographics
NPI:1194916940
Name:PROCTOR, REXANNE (RN)
Entity type:Individual
Prefix:MS
First Name:REXANNE
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122
Mailing Address - Country:US
Mailing Address - Phone:405-787-7583
Mailing Address - Fax:
Practice Address - Street 1:2129 SW 59TH STREET
Practice Address - Street 2:ST ANTHONY SOUTH
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119
Practice Address - Country:US
Practice Address - Phone:405-713-5913
Practice Address - Fax:405-680-4151
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0064001163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse