Healthcare Provider Details

I. General information

NPI: 1811227911
Provider Name (Legal Business Name): OKWAPEDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N SHARTEL AVE STE 606
OKLAHOMA CITY OK
73103-2425
US

IV. Provider business mailing address

1211 N SHARTEL AVE STE 606
OKLAHOMA CITY OK
73103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 405-235-9955
  • Fax: 405-601-4044
Mailing address:
  • Phone: 405-235-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12416
License Number StateOK

VIII. Authorized Official

Name: DR. WAZIR S AHMAD
Title or Position: OWNER
Credential: M.D.
Phone: 405-235-9955