Provider Demographics
NPI:1295470375
Name:BOZEMAN, MATINA NICOLE
Entity Type:Individual
Prefix:
First Name:MATINA
Middle Name:NICOLE
Last Name:BOZEMAN
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 1:2510 N SAINT PETER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73141-2627
Mailing Address - Country:US
Mailing Address - Phone:405-754-9981
Mailing Address - Fax:
Practice Address - Street 1:15500 JEFFERSONS GARDEN CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1410
Practice Address - Country:US
Practice Address - Phone:405-330-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management