Provider Demographics
NPI:1245918747
Name:ROSENTHAL, CHARITY FAITH (NP-BC)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:FAITH
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:FAITH
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410205 E 1910 RD
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-7376
Mailing Address - Country:US
Mailing Address - Phone:580-271-1917
Mailing Address - Fax:
Practice Address - Street 1:114 N HIGH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2250
Practice Address - Country:US
Practice Address - Phone:580-271-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily