Provider Information for 1154800878
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Miss MIREILLE INDEM FONSA M.S
Sex: Female
NPI: 1154800878
Last Updated: 2021-04-08
Certification Date: 2021-04-08
Certification Date: 2021-04-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1154800878 | ||||||||
| Enumeration Date | 2018-08-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9210 S WESTERN AVE STE A-21 OKLAHOMA CITY, OK 73139-4982 United States Phone: 405-676-9227 | Fax: | ||||||||
| Primary Practice Address | 9210 S WESTERN AVE STE A-21 OKLAHOMA CITY, OK 73139-4982 United States Phone: 405-676-9227 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|