Provider Demographics
NPI:1114520665
Name:FAIRBANKS, JOELISHA RAY'VON (DOULA)
Entity Type:Individual
Prefix:MRS
First Name:JOELISHA
Middle Name:RAY'VON
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-4232
Mailing Address - Country:US
Mailing Address - Phone:918-873-0250
Mailing Address - Fax:
Practice Address - Street 1:7901 NE 10TH ST STE B101
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3653
Practice Address - Country:US
Practice Address - Phone:405-795-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula