MEDICARE: AMELIA HENISE

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1427416031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA HENISE

Provider Business Mailing Address
First Line	:	2700 NW 63RD ST
Second Line	:	APT 30
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-4810
Country	:	US
Telephone Number	:	717-887-3311
Fax Number	:	405-225-7326

Provider Business Practice Location Address
First Line	:	2700 NW 63RD ST
Second Line	:	APT 30
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-4810
Country	:	US
Telephone Number	:	717-887-3311
Fax Number	:	405-225-7326

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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Directions to “ AMELIA HENISE ” Practice Location

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