Healthcare Provider Details

I. General information

NPI: 1982343398
Provider Name (Legal Business Name): OLIVEAH ADRIANNA JUANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16538 N MAY AVE
EDMOND OK
73012-9007
US

IV. Provider business mailing address

14600 N ROCKWELL AVE APT 1006
OKLAHOMA CITY OK
73142-8211
US

V. Phone/Fax

Practice location:
  • Phone: 917-946-0013
  • Fax:
Mailing address:
  • Phone: 580-418-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: