Healthcare Provider Details

I. General information

NPI: 1477751196
Provider Name (Legal Business Name): ENIENI ELIZABETH OKOYA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E. MAIN STREET, RED ROCK BEHAVIORAL HEALTH SERVICES BUILDING 52-100
NORMAN OK
73071
US

IV. Provider business mailing address

2804 PECAN VLY
NORMAN OK
73069-1202
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-4800
  • Fax:
Mailing address:
  • Phone: 405-694-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number91263
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: