# NEW IDENTITY FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SHADOW NURSING INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184586125
- **Authorized official:** MONICA A. TUCKER RN (RN ADMINISTRATION)
- **Authorized official phone:** (405) 824-1378

## Contact information

- **Practice address:** 613 NW 117TH ST, OKLAHOMA CITY, OK 73114-7922
- **Practice address phone:** (405) 824-1378
- **Mailing address:** 1211 PINE VLY, EDMOND, OK 73012-4364
- **Mailing address phone:** (405) 824-1378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WA2000X | Administrator Registered Nurse | — | — | — |
| 163WC0400X | Case Management Registered Nurse | — | — | — |
| 163WM1400X | Nurse Massage Therapist (NMT) | — | — | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |

## Other

- **Enumeration date:** 11/28/2025
- **Last updated:** 11/28/2025