Healthcare Provider Details

I. General information

NPI: 1992327563
Provider Name (Legal Business Name): SHANA USIUKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STANTON L YOUNG BLVD STE 6300
OKLAHOMA CITY OK
73104-5018
US

IV. Provider business mailing address

1200 CHILDRENS AVE STE 11200
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-436-9578
  • Fax:
Mailing address:
  • Phone: 405-271-3445
  • Fax: 405-271-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35774
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: