Healthcare Provider Details

I. General information

NPI: 1497494256
Provider Name (Legal Business Name): TRINITY LACTATION CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 E 21ST ST STE 6
TULSA OK
74114-1719
US

IV. Provider business mailing address

835 W 149TH PL S
GLENPOOL OK
74033-4327
US

V. Phone/Fax

Practice location:
  • Phone: 918-984-5355
  • Fax:
Mailing address:
  • Phone: 918-984-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLIVIA M BOCK
Title or Position: OWNER
Credential: RN
Phone: 918-984-5355