Provider Demographics
NPI:1245609650
Name:WINDHAM, RENEA
Entity Type:Individual
Prefix:
First Name:RENEA
Middle Name:
Last Name:WINDHAM
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 1:7909 N MCKEE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4318
Mailing Address - Country:US
Mailing Address - Phone:405-570-4447
Mailing Address - Fax:
Practice Address - Street 1:7909 N MCKEE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4318
Practice Address - Country:US
Practice Address - Phone:405-570-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist