MEDICARE: LISA ELAINE PARENICA

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1700699022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ELAINE PARENICA

Provider Business Mailing Address
First Line	:	1029 FLAMINGO AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-5013
Country	:	US
Telephone Number	:	405-905-5557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 FLAMINGO AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-5013
Country	:	US
Telephone Number	:	405-905-5557
Fax Number	:

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

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	01/30/2025

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Directions to “ LISA ELAINE PARENICA ” Practice Location

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