Healthcare Provider Details

I. General information

NPI: 1083428148
Provider Name (Legal Business Name): TEMBENG MARILYN TIKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W WILSHIRE BLVD STE 403C
NICHOLS HILLS OK
73116-7055
US

IV. Provider business mailing address

1000 W WILSHIRE BLVD STE 403C
NICHOLS HILLS OK
73116-7055
US

V. Phone/Fax

Practice location:
  • Phone: 405-505-2505
  • Fax:
Mailing address:
  • Phone: 405-474-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203932
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: