Provider Demographics
NPI:1881364594
Name:GILEAD TELEHEALTH
Entity type:Organization
Organization Name:GILEAD TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALINE
Authorized Official - Middle Name:ETAWU
Authorized Official - Last Name:EPIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP, PMHNP
Authorized Official - Phone:240-551-3447
Mailing Address - Street 1:200 VICKSBURG AVE APT M2
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2479
Mailing Address - Country:US
Mailing Address - Phone:240-551-3447
Mailing Address - Fax:
Practice Address - Street 1:200 VICKSBURG AVE APT M2
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-2479
Practice Address - Country:US
Practice Address - Phone:240-551-3447
Practice Address - Fax:405-217-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKEINMedicaid