Individual
BEULAH DISMUKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
351 N AIR DEPOT BLVD, 351 N AIR DEPOT SUITE S, MIDWEST CITY, OK 73110-1700
(405) 610-6540
Mailing address
6454 W WILSHIRE BLVD APT D, 351 N AIR DEPOT SUITE S, OKLAHOMA CITY, OK 73132-5451
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447559711
NPI
OK
Enumeration date
11/05/2011
Last updated
11/05/2011
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