Provider Demographics
NPI:1790445294
Name:OAKMAN, DANTE (MS, ADMIN HS)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:OAKMAN
Suffix:
Gender:M
Credentials:MS, ADMIN HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 E CLIVEDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2313
Mailing Address - Country:US
Mailing Address - Phone:215-678-0072
Mailing Address - Fax:
Practice Address - Street 1:241 E CLIVEDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2313
Practice Address - Country:US
Practice Address - Phone:215-678-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103888260-0001Medicaid