Healthcare Provider Details

I. General information

NPI: 1114384542
Provider Name (Legal Business Name): MOBILE HEALTH GLOBAL FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 MAIN ST # 277
GRANDVIEW MO
64030-2538
US

IV. Provider business mailing address

1503 MAIN ST # 277
GRANDVIEW MO
64030-2538
US

V. Phone/Fax

Practice location:
  • Phone: 913-206-8894
  • Fax: 913-660-0536
Mailing address:
  • Phone: 913-206-8894
  • Fax: 913-660-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number26D2106942
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. ZAKIYA MARYAM ORAEFO
Title or Position: PRESIDENT/CEO & LAB DIRECTOR
Credential: MSC, MSHS, PHDC
Phone: 913-206-8894