Basic Information
| Provider Information | |||||||||
| NPI: | 1457803520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NUMFOR | ||||||||
| FirstName: | BIH | ||||||||
| MiddleName: | RHODA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 218 | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740160218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183418100 | ||||||||
| FaxNumber: | 9183418139 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 E BLUE STARR DR | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740174223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183418100 | ||||||||
| FaxNumber: | 9183418139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2016 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 96497 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.