Healthcare Provider Details

I. General information

NPI: 1497793335
Provider Name (Legal Business Name): NEWBORN SPECIALISTS OF TULSA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE SUITE 2123
TULSA OK
74104-4012
US

IV. Provider business mailing address

1120 S UTICA AVE SUITE 2123
TULSA OK
74104-4012
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-5402
  • Fax: 918-579-5404
Mailing address:
  • Phone: 918-579-5402
  • Fax: 918-579-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSE WYRICK
Title or Position: OFFICE MANAGER
Credential: CAPPM
Phone: 918-579-5402