=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699932871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF OK COLLEGE OF NURSING, CASE MGMT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2008
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2220 N CLASSEN BLVD SUITE A
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73106-5809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-271-8767
-----------------------------------------------------
Fax | 405-271-2626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2220 N CLASSEN BLVD SUITE A
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73106-5809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-271-8767
-----------------------------------------------------
Fax | 405-271-2626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, CLINICAL OPERATIONS
-----------------------------------------------------
Name | GINA M FISHER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 405-271-8767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------