Provider Demographics
NPI:1669777421
Name:WIAFE, KWAME
Entity type:Individual
Prefix:MR
First Name:KWAME
Middle Name:
Last Name:WIAFE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KWAME
Other - Middle Name:
Other - Last Name:WIAFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3113 N GLADE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3649
Mailing Address - Country:US
Mailing Address - Phone:405-418-3859
Mailing Address - Fax:
Practice Address - Street 1:301 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7907
Practice Address - Country:US
Practice Address - Phone:405-418-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator