Provider Demographics
NPI:1780164566
Name:PAHAMARK, SASIPHA (APRN)
Entity type:Individual
Prefix:
First Name:SASIPHA
Middle Name:
Last Name:PAHAMARK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 WASHINGTON DR #101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1001
Mailing Address - Country:US
Mailing Address - Phone:405-857-8880
Mailing Address - Fax:405-279-0285
Practice Address - Street 1:2781 WASHINGTON DR #101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1001
Practice Address - Country:US
Practice Address - Phone:405-857-8880
Practice Address - Fax:405-279-0285
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF08180235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily