Healthcare Provider Details

I. General information

NPI: 1629874342
Provider Name (Legal Business Name): MARISHA NESHA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

13616 BRAMPTON WAY
YUKON OK
73099-6593
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8001
  • Fax:
Mailing address:
  • Phone: 405-243-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberR0100102
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: