MEDICARE: MR. INNOCENT ONYEMA NNONAH MSC

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
1	101YM0800X	Mental Health Counselor	NIL

General Provider Information

NPI Number	:	1649598103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. INNOCENT ONYEMA NNONAH MSC

Provider Business Mailing Address
First Line	:	6808 NW 25TH ST
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-5225
Country	:	US
Telephone Number	:	405-789-3189
Fax Number	:	405-604-0301

Provider Business Practice Location Address
First Line	:	2608 SW 59TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-6616
Country	:	US
Telephone Number	:	405-604-0300
Fax Number	:	405-604-0301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2010
Last Update Date	:	05/08/2010

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