Provider Demographics
NPI:1760937221
Name:AKONUMBO, CONSTANCE SILI (STUDENT COUNSELOR)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:SILI
Last Name:AKONUMBO
Suffix:
Gender:F
Credentials:STUDENT COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 N MERIDIAN AVE
Mailing Address - Street 2:APT. 215
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1001
Mailing Address - Country:US
Mailing Address - Phone:405-408-1244
Mailing Address - Fax:
Practice Address - Street 1:2614 N MERIDIAN AVE
Practice Address - Street 2:APT. 215
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1001
Practice Address - Country:US
Practice Address - Phone:405-408-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37H041870112376K00000X
OK37V509940714376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide