Provider Demographics
NPI:1033356845
Name:WHITNEY ROBERTSON, DEDRA DENISE (RN)
Entity type:Individual
Prefix:
First Name:DEDRA
Middle Name:DENISE
Last Name:WHITNEY ROBERTSON
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 1:9908 SAHARA DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7517
Mailing Address - Country:US
Mailing Address - Phone:405-684-6512
Mailing Address - Fax:
Practice Address - Street 1:9908 SAHARA DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-7517
Practice Address - Country:US
Practice Address - Phone:405-684-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0082411163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse