Provider Demographics
NPI:1306955141
Name:WHITEHOUSE, RACHEL LYNNE (DO)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNNE
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1656
Mailing Address - Country:US
Mailing Address - Phone:918-251-2666
Mailing Address - Fax:918-258-7790
Practice Address - Street 1:705 W OAKLAND ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1656
Practice Address - Country:US
Practice Address - Phone:918-251-2666
Practice Address - Fax:918-258-7790
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2983207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089970AMedicaid
OKE92811Medicare UPIN