Healthcare Provider Details

I. General information

NPI: 1225802275
Provider Name (Legal Business Name): ANTOENETE LUSHANE ZACHARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5814 S OWASSO AVE APT 1231
TULSA OK
74105-8415
US

IV. Provider business mailing address

5814 S OWASSO AVE APT 1231
TULSA OK
74105-8415
US

V. Phone/Fax

Practice location:
  • Phone: 918-889-5967
  • Fax:
Mailing address:
  • Phone: 918-889-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: