Mika Danette Riddle
Peer Specialist in Vinita, OK. Individual provider (NPI-1).
NPI number1639780935
StatusActive
Last updated in NPPESNov 10, 2020
Details
- NPI
- 1639780935
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Mika Danette Riddle
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 11, 2020
- Certification date
- Nov 10, 2020
- Last updated
- Nov 10, 2020
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 918-265-6476
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