Individual
CANISIA BONGFEN TATAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5209 S HARVARD AVE APT C, TULSA, OK 74135-3546
(405) 875-2075
Mailing address
5209 S HARVARD AVE APT C, TULSA, OK 74135-3546
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/15/2021
Last updated
11/15/2021
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