Healthcare Provider Details

I. General information

NPI: 1245603471
Provider Name (Legal Business Name): WENDY DEE WILSON RDN, LD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS WENDY DEE WELLS

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SW 156TH ST
OKLAHOMA CITY OK
73170-7614
US

IV. Provider business mailing address

720 SW 156TH ST
OKLAHOMA CITY OK
73170-7614
US

V. Phone/Fax

Practice location:
  • Phone: 405-615-0686
  • Fax:
Mailing address:
  • Phone: 405-615-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-302871
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2098
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: