Provider Demographics
NPI:1063157121
Name:FADEL, REANNA GABRIELLE
Entity type:Individual
Prefix:
First Name:REANNA
Middle Name:GABRIELLE
Last Name:FADEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REANNA
Other - Middle Name:
Other - Last Name:FADEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4108 PALMETTO TRAIL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-2403
Mailing Address - Country:US
Mailing Address - Phone:405-408-8642
Mailing Address - Fax:
Practice Address - Street 1:2617 GENERAL PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6437
Practice Address - Country:US
Practice Address - Phone:405-858-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator