Healthcare Provider Details

I. General information

NPI: 1104600600
Provider Name (Legal Business Name): RACHAEL N MOKUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 N KELLEY AVE STE 100
OKLAHOMA CITY OK
73111-4520
US

IV. Provider business mailing address

10400 N COUNCIL RD APT 118
OKLAHOMA CITY OK
73162-4356
US

V. Phone/Fax

Practice location:
  • Phone: 405-524-5525
  • Fax:
Mailing address:
  • Phone: 405-512-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: