Provider Demographics
NPI:1609099886
Name:VANCLEAVE, ROBIN K (PA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:K
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:MEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:11200 N PORTLAND AVE
Mailing Address - Street 2:2ND
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5045
Mailing Address - Country:US
Mailing Address - Phone:405-936-1000
Mailing Address - Fax:405-936-1001
Practice Address - Street 1:11200 N PORTLAND AVE
Practice Address - Street 2:2ND
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5045
Practice Address - Country:US
Practice Address - Phone:405-936-1000
Practice Address - Fax:405-936-1001
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244509005Medicare ID - Type Unspecified