Healthcare Provider Details

I. General information

NPI: 1568260958
Provider Name (Legal Business Name): RESOLUTION WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 S LEWIS AVE STE 100
TULSA OK
74105-5178
US

IV. Provider business mailing address

4880 S LEWIS AVE STE 100
TULSA OK
74105-5178
US

V. Phone/Fax

Practice location:
  • Phone: 918-852-6861
  • Fax:
Mailing address:
  • Phone: 918-852-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSH MOUSHON
Title or Position: CEO
Credential: APRN
Phone: 918-852-6861