Healthcare Provider Details

I. General information

NPI: 1376785238
Provider Name (Legal Business Name): SLEEP SOLUTIONS NORTHWEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N BROOKLINE AVE STE. 325
OKLAHOMA CITY OK
73112-3623
US

IV. Provider business mailing address

5100 N BROOKLINE AVE STE. 325
OKLAHOMA CITY OK
73112-3623
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-0060
  • Fax: 405-949-0412
Mailing address:
  • Phone: 405-949-0060
  • Fax: 405-949-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JON W NELSON
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 405-702-8623