Allegra Riley Desiree Birdwell
Peer Specialist in Vinita, OK. Individual provider (NPI-1).
NPI number1104523844
StatusActive
Last updated in NPPESFeb 13, 2023
Details
- NPI
- 1104523844
- Entity type
- Individual (NPI-1)
- Name
- Allegra Riley Desiree Birdwell
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 13, 2023
- Certification date
- Feb 13, 2023
- Last updated
- Feb 13, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 175T00000X | Peer Specialist | – | – | Yes |
Practice location
405 E Excelsior AveVinita, OK 74301-4226
Phone 918-256-6476
Mailing address
405 E Excelsior AveVinita, OK 74301-4226
Phone 918-256-6476
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