Healthcare Provider Details

I. General information

NPI: 1639670649
Provider Name (Legal Business Name): ISABELLE ZLATNIK APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2018
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number106086
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: