Provider Demographics
NPI:1699932871
Name:UNIVERSITY OF OK COLLEGE OF NURSING, CASE MGMT
Entity type:Organization
Organization Name:UNIVERSITY OF OK COLLEGE OF NURSING, CASE MGMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-271-8767
Mailing Address - Street 1:2220 N CLASSEN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5809
Mailing Address - Country:US
Mailing Address - Phone:405-271-8767
Mailing Address - Fax:405-271-2626
Practice Address - Street 1:2220 N CLASSEN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5809
Practice Address - Country:US
Practice Address - Phone:405-271-8767
Practice Address - Fax:405-271-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100686800 AMedicaid