Healthcare Provider Details

I. General information

NPI: 1194989483
Provider Name (Legal Business Name): AMANDA YVETTE WOODY CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3834 S 121ST EAST AVE
TULSA OK
74146-3313
US

IV. Provider business mailing address

3834 S 121ST EAST AVE
TULSA OK
74146-3313
US

V. Phone/Fax

Practice location:
  • Phone: 918-850-9884
  • Fax:
Mailing address:
  • Phone: 918-850-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: