Healthcare Provider Details

I. General information

NPI: 1710343694
Provider Name (Legal Business Name): MILDRED AKUA TWUM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

413 SW 170TH TER
OKLAHOMA CITY OK
73170-6678
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4299
  • Fax:
Mailing address:
  • Phone: 405-473-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number86514
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number86514
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: