Provider Demographics
NPI:1225802275
Name:ZACHARY, ANTOENETE LUSHANE
Entity Type:Individual
Prefix:
First Name:ANTOENETE
Middle Name:LUSHANE
Last Name:ZACHARY
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 1:5814 S OWASSO AVE APT 1231
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-8415
Mailing Address - Country:US
Mailing Address - Phone:918-889-5967
Mailing Address - Fax:
Practice Address - Street 1:5814 S OWASSO AVE APT 1231
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-8415
Practice Address - Country:US
Practice Address - Phone:918-889-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula