Canisia Bongfen Tatah
Student in an Organized Health Care Education/Training Program in Tulsa, OK. Individual provider (NPI-1).
NPI number1114683067
StatusActive
Last updated in NPPESNov 15, 2021
Details
- NPI
- 1114683067
- Entity type
- Individual (NPI-1)
- Name
- Canisia Bongfen Tatah
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 15, 2021
- Certification date
- Nov 15, 2021
- Last updated
- Nov 15, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
5209 S Harvard Ave Apt CTulsa, OK 74135-3546
Phone 405-875-2075
Mailing address
5209 S Harvard Ave Apt CTulsa, OK 74135-3546
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