Healthcare Provider Details

I. General information

NPI: 1770182065
Provider Name (Legal Business Name): IFEOLUWA OCHUWA IDODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 BIGWOOD DRIVE
OKLAHOMA CITY OK
73135
US

IV. Provider business mailing address

PO BOX 765
CHOCTAW OK
73020-0765
US

V. Phone/Fax

Practice location:
  • Phone: 405-923-0722
  • Fax:
Mailing address:
  • Phone: 405-923-0722
  • 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: