Provider Demographics
NPI:1427334234
Name:DEHAAS, ANNE-MARIE (MHR)
Entity type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:DEHAAS
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:ANNE-MARIE
Other - Middle Name:
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHR
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:OK
Mailing Address - Zip Code:74651-0009
Mailing Address - Country:US
Mailing Address - Phone:580-304-6962
Mailing Address - Fax:
Practice Address - Street 1:1500 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2827
Practice Address - Country:US
Practice Address - Phone:580-762-7561
Practice Address - Fax:580-762-2576
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator