Healthcare Provider Details

I. General information

NPI: 1841002243
Provider Name (Legal Business Name): SANA WOUND CARE OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E 41ST ST STE 108A
TULSA OK
74105-3739
US

IV. Provider business mailing address

18 W COLT SQUARE DR
FAYETTEVILLE AR
72703
US

V. Phone/Fax

Practice location:
  • Phone: 479-480-6677
  • Fax: 479-485-3752
Mailing address:
  • Phone: 479-480-6677
  • Fax: 479-485-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KATINKA VAN DER MERWE
Title or Position: OWNER
Credential: DC
Phone: 479-480-6677