Healthcare Provider Details

I. General information

NPI: 1255698718
Provider Name (Legal Business Name): GWENDOLYN J SYKES BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 WATERWOOD PKWY STE OFFICEB2
EDMOND OK
73034-5327
US

IV. Provider business mailing address

1015 WATERWOOD PKWY STE OFFICEB2
EDMOND OK
73034-5327
US

V. Phone/Fax

Practice location:
  • Phone: 408-844-8085
  • Fax: 405-285-2186
Mailing address:
  • Phone: 408-844-8085
  • Fax: 405-285-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: