1972829901 NPI number — MS. LISA DE AMBER KOMAHCHEET LADC

Table of content: MS. LISA DE AMBER KOMAHCHEET LADC (NPI 1972829901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972829901 NPI number — MS. LISA DE AMBER KOMAHCHEET LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOMAHCHEET
Provider First Name:
LISA
Provider Middle Name:
DE AMBER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOMAHCHEET
Provider Other First Name:
AMBER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LADC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972829901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3212 SW 104TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73159-7800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-213-3700
Provider Business Mailing Address Fax Number:
405-208-4574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3212 SW 104TH TER
Provider Second Line Business Practice Location Address:
2915 N CLASSEN BLVD. SUITE 325
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73159-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-213-3700
Provider Business Practice Location Address Fax Number:
405-208-4574
Provider Enumeration Date:
04/15/2010

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 , with the licence number:  #588 , 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)





Copyright © 2007-2025 www.npivalidator.com