Provider Demographics
NPI:1386674125
Name:SMITH, MARIA AGNES ESSIEN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIA AGNES
Middle Name:ESSIEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
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Other - Credentials:
Mailing Address - Street 1:10444 GREENBRIAR PLACE SUITE C
Mailing Address - Street 2:EBENEZER HEALTH CARE SERVICES, PC
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7660
Mailing Address - Country:US
Mailing Address - Phone:405-378-2119
Mailing Address - Fax:405-759-7022
Practice Address - Street 1:10444 GREENBRIAR PLACE, SUITE C
Practice Address - Street 2:EBENEZER HEALTH CARE SERVICES, PC
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7660
Practice Address - Country:US
Practice Address - Phone:405-378-2119
Practice Address - Fax:405-759-7022
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0070234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100056310AMedicaid
OK100056310AMedicaid
OKP52427Medicare UPIN