Provider Demographics
NPI:1447677281
Name:TOOTILL, RHONDA (FNP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:TOOTILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2138
Mailing Address - Country:US
Mailing Address - Phone:918-683-8442
Mailing Address - Fax:918-683-8390
Practice Address - Street 1:3505 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2138
Practice Address - Country:US
Practice Address - Phone:918-683-8442
Practice Address - Fax:918-683-8390
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0069798363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care