Healthcare Provider Details

I. General information

NPI: 1720596943
Provider Name (Legal Business Name): JOY MARIE MAISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5018
US

IV. Provider business mailing address

5310 E 31ST ST
TULSA OK
74135-5018
US

V. Phone/Fax

Practice location:
  • Phone: 918-815-9507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number208535
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: