Provider Demographics
NPI:1427246008
Name:AHLEFELD, DORSA DIANNE (ARNP)
Entity type:Individual
Prefix:MS
First Name:DORSA
Middle Name:DIANNE
Last Name:AHLEFELD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:DORSA
Other - Middle Name:SELF
Other - Last Name:AHLEFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1200 CHILDRENS AVE
Mailing Address - Street 2:SUITE 7D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-3800
Mailing Address - Fax:405-271-3399
Practice Address - Street 1:1200 CHILDRENS AVE
Practice Address - Street 2:SUITE 7D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-3800
Practice Address - Fax:405-271-3399
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0078915363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200208950AMedicaid