Basic Information
| Provider Information | |||||||||
| NPI: | 1588286728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HISHAW | ||||||||
| FirstName: | NAKIA | ||||||||
| MiddleName: | SHANAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10417 BUCCANEER DR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731596039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058865092 | ||||||||
| FaxNumber: | 4056049689 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W I 240 SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731397701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056353864 | ||||||||
| FaxNumber: | 4056049689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2020 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.