Healthcare Provider Details

I. General information

NPI: 1144560293
Provider Name (Legal Business Name): NICHOLAS NYAMBEGERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 NW EXPRESSWAY STE 200
OKLAHOMA CITY OK
73132-1534
US

IV. Provider business mailing address

12724 NE 38TH ST
SPENCER OK
73084-9155
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-0452
  • Fax:
Mailing address:
  • Phone: 505-553-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: