1669698957 NPI number — MRS. ROBYN LORRAINE UNDIEME MA MFT

Table of content: MRS. ROBYN LORRAINE UNDIEME MA MFT (NPI 1669698957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669698957 NPI number — MRS. ROBYN LORRAINE UNDIEME MA MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDIEME
Provider First Name:
ROBYN
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUREK
Provider Other First Name:
ROBYN
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669698957
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:
650 S PEORIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74120-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-587-9471
Provider Business Mailing Address Fax Number:
918-560-0137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11740 E 21ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74129-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-437-0596
Provider Business Practice Location Address Fax Number:
918-234-4554
Provider Enumeration Date:
04/17/2007

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: 101Y00000X , 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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