Healthcare Provider Details

I. General information

NPI: 1679255582
Provider Name (Legal Business Name): IMAREE WRENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IMAREE MCINNIS

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N GREENWOOD AVE STE 131
TULSA OK
74120-1444
US

IV. Provider business mailing address

538 E LATIMER PL
TULSA OK
74106-4822
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-7277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: