Healthcare Provider Details

I. General information

NPI: 1194134726
Provider Name (Legal Business Name): CHOCTAW WOMENS CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14890 SE 29TH ST SUITE 106
CHOCTAW OK
73020-3515
US

IV. Provider business mailing address

14890 SE 29TH STREET SUITE 106
CHOCTAW OK
73020
US

V. Phone/Fax

Practice location:
  • Phone: 405-620-0049
  • Fax: 405-234-9476
Mailing address:
  • Phone: 405-620-0049
  • Fax: 405-234-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARA MARIE BOTCHLET
Title or Position: OWNER
Credential:
Phone: 405-620-0049