Provider Demographics
NPI:1043622335
Name:MOBACK, TAUNA
Entity Type:Individual
Prefix:
First Name:TAUNA
Middle Name:
Last Name:MOBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-3505
Mailing Address - Country:US
Mailing Address - Phone:918-308-5518
Mailing Address - Fax:918-786-4435
Practice Address - Street 1:1115 HARBOR RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3505
Practice Address - Country:US
Practice Address - Phone:918-308-5518
Practice Address - Fax:918-786-4435
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator