Provider Demographics
NPI:1720551674
Name:MAHTUSHQUAH, MEAGAN (APRN)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:MAHTUSHQUAH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 WILMINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2232
Mailing Address - Country:US
Mailing Address - Phone:405-948-4900
Mailing Address - Fax:
Practice Address - Street 1:3916 S SUNNYLANE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3656
Practice Address - Country:US
Practice Address - Phone:405-812-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK117483163W00000X
OK220103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse