Healthcare Provider Details

I. General information

NPI: 1871403501
Provider Name (Legal Business Name): MS. JUDITH CHINWE ASIKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 QUEENSTON AVE
NORMAN OK
73071-3845
US

IV. Provider business mailing address

10673 W LAKE HAZEL RD # 79
BOISE ID
83709-5453
US

V. Phone/Fax

Practice location:
  • Phone: 208-280-2830
  • Fax:
Mailing address:
  • Phone: 208-280-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number230331
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: