Provider Demographics
NPI:1467977447
Name:ATEM, QUINTA AJEBEKONG
Entity Type:Individual
Prefix:
First Name:QUINTA
Middle Name:AJEBEKONG
Last Name:ATEM
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 1:2626 N MERIDIAN AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1004
Mailing Address - Country:US
Mailing Address - Phone:405-361-1876
Mailing Address - Fax:
Practice Address - Street 1:2626 N MERIDIAN AVE APT 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1004
Practice Address - Country:US
Practice Address - Phone:405-361-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management