Provider Demographics
NPI:1699490888
Name:NIBBS, WISDOM LAFORCE-HAMILTON
Entity type:Individual
Prefix:MR
First Name:WISDOM
Middle Name:LAFORCE-HAMILTON
Last Name:NIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 NW 23RD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2043
Mailing Address - Country:US
Mailing Address - Phone:949-929-7698
Mailing Address - Fax:
Practice Address - Street 1:1501 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6611
Practice Address - Country:US
Practice Address - Phone:405-235-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist