Basic Information
| Provider Information | |||||||||
| NPI: | 1255997771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESPINOSA | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | NCPRSS, BHWC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 N LINCOLN BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731055108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803239766 | ||||||||
| FaxNumber: | 5803235635 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 N 31ST ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736019116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803239766 | ||||||||
| FaxNumber: | 5803235635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2019 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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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 | 175T00000X | N | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.