Healthcare Provider Details

I. General information

NPI: 1639498298
Provider Name (Legal Business Name): ROSELINE NSIKAK MHR, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5104
US

IV. Provider business mailing address

14717 HOLLYHOCK DR
OKLAHOMA CITY OK
73142-1803
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-0452
  • Fax:
Mailing address:
  • Phone: 405-623-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: