Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 53-80085-082 | KS |
NPI | 1003584244 |
---|---|
Provider Name | Sasha Lounmala |
First Address | Bixby, OK 74008-0364 |
Second Address | Muskogee, OK 74401-1318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 08/09/2021 |