Healthcare Provider Details

I. General information

NPI: 1588094783
Provider Name (Legal Business Name): JOLENE RYCHTIK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PARKLAWN DR
MIDWEST CITY OK
73110-4201
US

IV. Provider business mailing address

PO BOX 708760
SANDY UT
84070-8760
US

V. Phone/Fax

Practice location:
  • Phone: 405-610-8993
  • Fax: 801-352-7976
Mailing address:
  • Phone: 801-352-9500
  • Fax: 801-352-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5592-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: