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Organization
NEW IDENTITY FOUNDATION
Active
Organization
NEW IDENTITY FOUNDATION
Active
Other names
SHADOW NURSING INC
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA A. TUCKER RN (RN ADMINISTRATION)
(405) 824-1378
Entity
Organization
Contact information
Practice address
613 NW 117TH ST, OKLAHOMA CITY, OK 73114-7922
(405) 824-1378
Mailing address
1211 PINE VLY, EDMOND, OK 73012-4364
(405) 824-1378
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
—
—
163WC0400X
Case Management Registered Nurse
—
—
163WM1400X
Nurse Massage Therapist (NMT)
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/28/2025
Last updated
11/28/2025
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