Healthcare Provider Details

I. General information

NPI: 1649898859
Provider Name (Legal Business Name): IWALEWA MONINUOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IWALEWA OLOWOPOROKU

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 5B
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

825 NE 10TH ST STE 5B
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3635
  • Fax: 405-271-2523
Mailing address:
  • Phone: 405-271-3635
  • Fax: 405-271-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number50014
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2020019663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: