Provider Demographics
NPI:1558944900
Name:MATAND, MUJING MAMY (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:MUJING
Middle Name:MAMY
Last Name:MATAND
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8690
Mailing Address - Country:US
Mailing Address - Phone:405-334-7189
Mailing Address - Fax:
Practice Address - Street 1:6117 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8690
Practice Address - Country:US
Practice Address - Phone:405-334-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily