Basic Information
| Provider Information | |||||||||
| NPI: | 1023782224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENFIELD | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | MASAKO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3540 OLD GEORGETOWNE RD | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730130805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055133970 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3000 UNITED FOUNDERS BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731123958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058407040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | OK | Y |
No ID Information.