Healthcare Provider Details

I. General information

NPI: 1255804316
Provider Name (Legal Business Name): ISABELLE ZLATNIK, APRN-CNP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 W GORE BLVD STE B1
LAWTON OK
73505-5977
US

IV. Provider business mailing address

4411 W GORE BLVD STE B1
LAWTON OK
73505-5977
US

V. Phone/Fax

Practice location:
  • Phone: 580-248-8000
  • Fax: 580-248-8001
Mailing address:
  • Phone: 580-248-8000
  • Fax: 580-248-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRUDY JANSON
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 580-248-8000