Provider Demographics
NPI:1770863912
Name:DISMUKE, VERNONA
Entity Type:Individual
Prefix:
First Name:VERNONA
Middle Name:
Last Name:DISMUKE
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 1:2000 NE GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-1828
Mailing Address - Country:US
Mailing Address - Phone:405-882-6434
Mailing Address - Fax:
Practice Address - Street 1:2000 NE GRAND BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-1828
Practice Address - Country:US
Practice Address - Phone:405-882-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator