Basic Information
| Provider Information | |||||||||
| NPI: | 1033639455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | TREVA | ||||||||
| MiddleName: | FREDA | ||||||||
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| Credential: | R.T.(R)(CT)(ARRT) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9717 NW 10TH ST TRLR 295 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731277464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059031852 | ||||||||
| FaxNumber: | 4059480837 | ||||||||
| Practice Location | |||||||||
| Address1: | 4913 W RENO AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731276339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059484900 | ||||||||
| FaxNumber: | 4059480837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3402X | OK | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography | 2471C3401X | OK | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography |
No ID Information.