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General NPI Number Information
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NPI Number | 1083190326
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Entity Type | Individual
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Provider Name | ELIZABETH AMELIA FORNONI
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Gender | Female
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 11740 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74129-1820
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Country | US
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Telephone | 918-437-9495
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Fax |
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Provider Business Mailing Address
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Address Line | 8748 N MINGO RD APT 1120
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City | OWASSO
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State | OK
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Zip | 74055-5076
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6270
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License Number State | OK
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