Provider Demographics
NPI:1780458794
Name:OCEANIC MEDICAL MANAGEMENT LLC
Entity type:Organization
Organization Name:OCEANIC MEDICAL MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:QUINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NKONKI
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:240-215-5291
Mailing Address - Street 1:7185 71ST ST S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-1726
Mailing Address - Country:US
Mailing Address - Phone:240-215-5291
Mailing Address - Fax:
Practice Address - Street 1:7185 71ST ST S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-1726
Practice Address - Country:US
Practice Address - Phone:240-215-5291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Single Specialty