Healthcare Provider Details

I. General information

NPI: 1720686124
Provider Name (Legal Business Name): WENDY WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 E PINE ST
TULSA OK
74106-4903
US

IV. Provider business mailing address

1301 W WOODROW ST
TULSA OK
74127-2715
US

V. Phone/Fax

Practice location:
  • Phone: 918-812-0299
  • Fax: 539-867-2819
Mailing address:
  • Phone: 918-829-0257
  • Fax: 539-867-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number49546
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: