Healthcare Provider Details

I. General information

NPI: 1841900172
Provider Name (Legal Business Name): ARRAY NUTRITION & LACTATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
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: 405-215-9248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. WENDY DEE WILSON
Title or Position: OWNER/MEMBER
Credential: RDN/LD, IBCLC
Phone: 405-615-0686