Provider Demographics
NPI:1871714782
Name:LINSE, DEBORA LYNN (RDH, DPH, CACP)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:LYNN
Last Name:LINSE
Suffix:
Gender:F
Credentials:RDH, DPH, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 HEFNER VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7741
Mailing Address - Country:US
Mailing Address - Phone:405-644-5128
Mailing Address - Fax:405-644-5129
Practice Address - Street 1:4221 S WESTERN AVE STE 1045
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3492
Practice Address - Country:US
Practice Address - Phone:405-644-5128
Practice Address - Fax:405-644-5129
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1259124Q00000X
OK11860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered124Q00000XDental ProvidersDental Hygienist
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0285-LAS-1205OtherANTICOAGULATION PROVIDER