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General NPI Number Information
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NPI Number | 1154640084
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Entity Type | Individual
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Provider Name | MRS. MADINAH JESSICA MUSLIM-GROOMS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 1000 W WILSHIRE BLVD SUITE 403E
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-7030
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Country | US
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Telephone | 405-250-5960
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Fax |
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Provider Business Mailing Address
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Address Line | 108 SAHOMA TER
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City | EDMOND
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State | OK
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Zip | 73013-4328
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Country | US
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Telephone | 405-824-9043
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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 | N/A
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License Number State |
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