Provider Demographics
NPI:1376052944
Name:NORTHSIDE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:NORTHSIDE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUBURI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP, PMHNP-BC
Authorized Official - Phone:405-814-6550
Mailing Address - Street 1:PO BOX 20327
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0327
Mailing Address - Country:US
Mailing Address - Phone:405-814-6550
Mailing Address - Fax:405-252-5651
Practice Address - Street 1:6051 N BROOKLINE AVE STE 122
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4286
Practice Address - Country:US
Practice Address - Phone:405-814-6550
Practice Address - Fax:210-640-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty