Provider Demographics
NPI:1962738666
Name:MBOH, HELEN EPONG (NP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:EPONG
Last Name:MBOH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 N. PORTLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2524
Mailing Address - Country:US
Mailing Address - Phone:405-949-1552
Mailing Address - Fax:
Practice Address - Street 1:1924 N. PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-949-1552
Practice Address - Fax:405-949-1570
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0083300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0083300OtherOKLAHOMA BOARD OF NURSING