Healthcare Provider Details

I. General information

NPI: 1669322236
Provider Name (Legal Business Name): ALTHEA MED SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S MAIN ST
SAPULPA OK
74066-5544
US

IV. Provider business mailing address

1320 S MAIN ST
SAPULPA OK
74066-5544
US

V. Phone/Fax

Practice location:
  • Phone: 539-432-1808
  • Fax:
Mailing address:
  • Phone: 539-432-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN AUBREY ROVANG
Title or Position: OWNER/APRN
Credential: DNP
Phone: 918-671-6210