MEDICARE: MIRIAM FAITH NANTUMBWE RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	228391	OK

General Provider Information

NPI Number	:	1407788839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM FAITH NANTUMBWE RN

Provider Business Mailing Address
First Line	:	2548 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6712
Country	:	US
Telephone Number	:	918-355-0993
Fax Number	:	918-355-0995

Provider Business Practice Location Address
First Line	:	2548 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6712
Country	:	US
Telephone Number	:	918-355-0993
Fax Number	:	918-355-0995

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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