Basic Information
| Provider Information | |||||||||
| NPI: | 1518370337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | EFUA ASAABA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 S YALE AVE STE 1400 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882470125 | ||||||||
| FaxNumber: | 9185028001 | ||||||||
| Practice Location | |||||||||
| Address1: | 6151 S YALE AVE STE 100A | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741361929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184948500 | ||||||||
| FaxNumber: | 9183075578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116027046 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0000X | 35687 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 200920940A | 05 | OK | MEDICAID | 0116027046 | 01 | VA | VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS | OTHER |