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NPI Code Detail

MEDICARE: MRS. DORETHA MARIE GUION-COLBERT CERT . IN CASE MGT

MEDICARE: MRS. DORETHA MARIE GUION-COLBERT CERT . IN CASE MGT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator21042OK

General Provider Information

NPI Number : 1477856136
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DORETHA MARIE GUION-COLBERT CERT . IN CASE MGT
Provider Business Mailing Address
First Line : 3305 E FOREST PARK DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73121-2225
Country : US
Telephone Number : 405-424-8352
Fax Number : 405-424-1624
Provider Business Practice Location Address
First Line : 3305 E FOREST PARK DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73121-2225
Country : US
Telephone Number : 405-424-8352
Fax Number : 405-424-1624
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2010
Last Update Date : 12/17/2010

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