Healthcare Provider Details

I. General information

NPI: 1619643483
Provider Name (Legal Business Name): MAGNOLIA HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE STE 300
TULSA OK
74104-5632
US

IV. Provider business mailing address

1919 S WHEELING AVE STE 300
TULSA OK
74104-5632
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-0701
  • Fax:
Mailing address:
  • Phone: 918-794-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BROOKE GOLWAS
Title or Position: OWNER & OPERATOR
Credential: APRN-CNP
Phone: 918-794-0701