Provider Demographics
NPI:1427835065
Name:EDWARDS, MIYANA (DIRECTOR OF LAB)
Entity type:Individual
Prefix:
First Name:MIYANA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DIRECTOR OF LAB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N COUNCIL RD APT 21D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-4971
Mailing Address - Country:US
Mailing Address - Phone:405-351-3357
Mailing Address - Fax:
Practice Address - Street 1:521 N COUNCIL RD APT 21D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-4971
Practice Address - Country:US
Practice Address - Phone:405-351-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37DD2287616291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory