Healthcare Provider Details

I. General information

NPI: 1467361345
Provider Name (Legal Business Name): MULWANDA HEALTHCARE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1310 S YORK ST
MUSKOGEE OK
74403-7650
US

IV. Provider business mailing address

6601 S SYCAMORE AVE
BROKEN ARROW OK
74011-6037
US

V. Phone/Fax

Practice location:
  • Phone: 918-269-9180
  • Fax:
Mailing address:
  • Phone: 918-269-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TONYA MARTIN
Title or Position: OWNER/MANAGER
Credential: FNP-BC
Phone: 918-269-9180