Individual
MRS. ELIZABETH LOUISE ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
6520 E RENO AVE, STE B, MIDWEST CITY, OK 73110
(405) 733-0120
(405) 733-7877
Mailing address
6520 E RENO AVE, STE B, MIDWEST CITY, OK 73110-2119
(405) 733-0120
(405) 733-7877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A01060
AR
363L00000X
Nurse Practitioner
Primary
95370
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144307554
GROUP NPI
OK
05
—
129607758
—
AR
01
—
1649201286
GROUP NPI
AR
05
—
200264120A
—
OK
01
—
BC5T024
BLUE CROSS
OK
Enumeration date
05/09/2006
Last updated
08/05/2019
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