Provider Demographics
NPI:1992947345
Name:MCMAHAN, ROSE MARIE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27586 E 705 RD
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-6698
Mailing Address - Country:US
Mailing Address - Phone:918-485-6107
Mailing Address - Fax:918-485-6106
Practice Address - Street 1:27546 E 705 RD
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-6698
Practice Address - Country:US
Practice Address - Phone:918-485-6107
Practice Address - Fax:918-485-6106
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0049238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily