Healthcare Provider Details

I. General information

NPI: 1528669785
Provider Name (Legal Business Name): 918 WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 E 15TH ST
TULSA OK
74104-4611
US

IV. Provider business mailing address

13236 N. 7TH ST. STE 4 #289
PHOENIX AZ
85022-5343
US

V. Phone/Fax

Practice location:
  • Phone: 918-218-2041
  • Fax: 918-218-2041
Mailing address:
  • Phone: 918-218-2041
  • Fax: 918-218-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY ELIZABETH LAWLER
Title or Position: MANAGER
Credential:
Phone: 314-378-5422