Provider Demographics
NPI:1912236852
Name:WHITEWATER, ZONA (MBS)
Entity Type:Individual
Prefix:
First Name:ZONA
Middle Name:
Last Name:WHITEWATER
Suffix:
Gender:F
Credentials:MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 QUAIL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-8948
Mailing Address - Country:US
Mailing Address - Phone:580-622-4103
Mailing Address - Fax:
Practice Address - Street 1:2530 SO. COMMERCE
Practice Address - Street 2:BLDG. B
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73402
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator