MEDICARE: MS. SHAH-MONEKE ANJONETTE GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1003459512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAH-MONEKE ANJONETTE GREEN

Provider Business Mailing Address
First Line	:	3800 SE 48TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2265
Country	:	US
Telephone Number	:	470-808-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 SE 48TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2265
Country	:	US
Telephone Number	:	470-808-9070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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