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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