Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1528358850 |
---|---|
Provider Name | Mrs. Ijeoma Gertrude Nwanebu III |
First Address | Oklahoma City, OK 73142-5922 |
Second Address | Oklahoma City, OK 73142-5922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 07/04/2011 |