Healthcare Provider Details

I. General information

NPI: 1700040680
Provider Name (Legal Business Name): PLW ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE # 8F
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

4719 MULBERRY ST
WOODWARD OK
73801-3854
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4750
  • Fax:
Mailing address:
  • Phone: 918-704-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: PAMALA L WILSON
Title or Position: OWNER /CEO
Credential: CRNA
Phone: 918-704-5556