Healthcare Provider Details

I. General information

NPI: 1760177877
Provider Name (Legal Business Name): PATRICIA NAOMI TEHAUNO AS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105365 S HIGHWAY 102
MCLOUD OK
74851-3051
US

IV. Provider business mailing address

910 N SHAWNEE AVE UNIT 2
SHAWNEE OK
74801-5315
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-2081
  • Fax:
Mailing address:
  • Phone: 405-432-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: