Healthcare Provider Details

I. General information

NPI: 1093595837
Provider Name (Legal Business Name): LANE WOLFHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2548 E KENOSHA ST
BROKEN ARROW OK
74014-6712
US

IV. Provider business mailing address

320 S PHOENIX AVE
TULSA OK
74127-8831
US

V. Phone/Fax

Practice location:
  • Phone: 918-355-0993
  • Fax:
Mailing address:
  • Phone: 720-243-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number322125
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: