1538233713 NPI number — MS. PHYLLIS CORNELLA NUNOO WILLIAMS MSW LCSW

Table of content: MS. PHYLLIS CORNELLA NUNOO WILLIAMS MSW LCSW (NPI 1538233713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538233713 NPI number — MS. PHYLLIS CORNELLA NUNOO WILLIAMS MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUNOO WILLIAMS
Provider First Name:
PHYLLIS
Provider Middle Name:
CORNELLA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NHNOO
Provider Other First Name:
PHYLLIS
Provider Other Middle Name:
CORNELIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538233713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDWEST CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73140-5405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-741-1591
Provider Business Mailing Address Fax Number:
405-741-1593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 NE 10TH STREET
Provider Second Line Business Practice Location Address:
SUITE B202
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73110-7453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-741-1591
Provider Business Practice Location Address Fax Number:
405-741-1593
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0424 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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