Provider Demographics
NPI:1144660739
Name:GIVENS, ONREKA
Entity type:Individual
Prefix:
First Name:ONREKA
Middle Name:
Last Name:GIVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 SW ARBUCKLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8215
Mailing Address - Country:US
Mailing Address - Phone:580-917-7780
Mailing Address - Fax:
Practice Address - Street 1:633 SW ARBUCKLE AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8215
Practice Address - Country:US
Practice Address - Phone:580-917-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor