Provider Demographics
NPI:1528141280
Name:MBOSOWO, MARY DONALD (B A,M A PHD)
Entity type:Individual
Prefix:PROF
First Name:MARY
Middle Name:DONALD
Last Name:MBOSOWO
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Gender:F
Credentials:B A,M A PHD
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Mailing Address - Street 1:2616 REDVINE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4241
Mailing Address - Country:US
Mailing Address - Phone:405-341-7779
Mailing Address - Fax:405-285-5847
Practice Address - Street 1:2324 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2208
Practice Address - Country:US
Practice Address - Phone:405-948-0777
Practice Address - Fax:405-948-1777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4814570001Medicare NSC