Basic Information
Provider Information | |||||||||
NPI: | 1114273737 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOWARD | ||||||||
FirstName: | DENESHEIA | ||||||||
MiddleName: | MONET' | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RMA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | OSBORNE | ||||||||
OtherFirstName: | DENESHIA | ||||||||
OtherMiddleName: | MONET' | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RMA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4913 W RENO AVE | ||||||||
Address2: |   | ||||||||
City: | OKLAHOMA CITY | ||||||||
State: | OK | ||||||||
PostalCode: | 731276339 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4059484900 | ||||||||
FaxNumber: | 4055953197 | ||||||||
Practice Location | |||||||||
Address1: | 4913 W RENO AVE | ||||||||
Address2: |   | ||||||||
City: | OKLAHOMA CITY | ||||||||
State: | OK | ||||||||
PostalCode: | 731276339 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4059484900 | ||||||||
FaxNumber: | 4055953197 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2012 | ||||||||
LastUpdateDate: | 08/16/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | RMA 2598570 | OK | Y |   | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other |   |
No ID Information.