Healthcare Provider Details

I. General information

NPI: 1588108831
Provider Name (Legal Business Name): JOHNNA ERBES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SE FRANK PHILLIPS BLVD
BARTLESVILLE OK
74003-4318
US

IV. Provider business mailing address

1110 SE FRANK PHILLIPS BLVD
BARTLESVILLE OK
74003-4318
US

V. Phone/Fax

Practice location:
  • Phone: 918-336-0810
  • Fax: 918-336-0836
Mailing address:
  • Phone: 918-336-0810
  • Fax: 918-336-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: