MEDICARE: MRS. RITA HAYWOOD WINGO ARNP,BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R0051993	OK

General Provider Information

NPI Number	:	1700987534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA HAYWOOD WINGO ARNP,BC

Provider Business Mailing Address
First Line	:	921 NE 13TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5007
Country	:	US
Telephone Number	:	405-270-0501
Fax Number	:

Provider Business Practice Location Address
First Line	:	3124 LAKESIDE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2315
Country	:	US
Telephone Number	:	405-751-6863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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