Healthcare Provider Details

I. General information

NPI: 1932434339
Provider Name (Legal Business Name): TASHA OAKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 KENWOOD CT APT 1
NORMAL IL
61761-4707
US

IV. Provider business mailing address

104 KENWOOD CT APT 1
NORMAL IL
61761-4707
US

V. Phone/Fax

Practice location:
  • Phone: 217-637-0399
  • Fax:
Mailing address:
  • Phone: 217-637-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: