Healthcare Provider Details

I. General information

NPI: 1881944031
Provider Name (Legal Business Name): MR. STANLEY NZUONKWELLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 SW 103RD ST
OKLAHOMA CITY OK
73159
US

IV. Provider business mailing address

3224 SW 103RD ST
OKLAHOMA CITY OK
73159
US

V. Phone/Fax

Practice location:
  • Phone: 678-777-8038
  • Fax:
Mailing address:
  • Phone: 405-942-4740
  • Fax: 405-208-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6053
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: