Provider Demographics
NPI:1073263497
Name:HARWICK, NINETTA (BACJ, MPA)
Entity Type:Individual
Prefix:
First Name:NINETTA
Middle Name:
Last Name:HARWICK
Suffix:
Gender:F
Credentials:BACJ, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 E 79TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3444
Mailing Address - Country:US
Mailing Address - Phone:918-908-0484
Mailing Address - Fax:
Practice Address - Street 1:6814 E 79TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3444
Practice Address - Country:US
Practice Address - Phone:918-908-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator