Healthcare Provider Details

I. General information

NPI: 1245868744
Provider Name (Legal Business Name): HANNAH WENDELBO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EVERETT DR STE 8305
OKLAHOMA CITY OK
73104-5047
US

IV. Provider business mailing address

1200 EVERETT DR STE 8305
OKLAHOMA CITY OK
73104-5047
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5211
  • Fax: 405-271-2945
Mailing address:
  • Phone: 405-271-5211
  • Fax: 405-271-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5239
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number9594
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0000005239
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: