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General NPI Number Information
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NPI Number | 1881364594
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Entity Type | Organization
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Legal Business Name | GILEAD TELEHEALTH
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 200 VICKSBURG AVE APT M2
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City | NORMAN
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State | OK
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Zip | 73071-2479
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Country | US
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Telephone | 240-551-3447
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Fax | 405-217-2058
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Provider Business Mailing Address
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Address Line | 200 VICKSBURG AVE APT M2
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City | NORMAN
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State | OK
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Zip | 73071-2479
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Country | US
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Telephone | 240-551-3447
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | MAGDALINE ETAWU EPIE
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Credential | APRN, CNP, PMHNP
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Telephone | 240-551-3447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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