Healthcare Provider Details

I. General information

NPI: 1245141779
Provider Name (Legal Business Name): MICHELLE N LUNGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 E ROCKPORT ST
BROKEN ARROW OK
74014-2056
US

IV. Provider business mailing address

6111 E SKELLY DR
TULSA OK
74135-6100
US

V. Phone/Fax

Practice location:
  • Phone: 918-510-7672
  • Fax:
Mailing address:
  • Phone: 918-232-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: