Provider Demographics
NPI:1023618758
Name:NYANYOUN, JONATHAN NYANQUOI
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NYANQUOI
Last Name:NYANYOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2218
Mailing Address - Country:US
Mailing Address - Phone:918-720-9645
Mailing Address - Fax:
Practice Address - Street 1:12508 E 34TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2218
Practice Address - Country:US
Practice Address - Phone:918-720-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management