Healthcare Provider Details

I. General information

NPI: 1336438274
Provider Name (Legal Business Name): MRS. JUDY MARLENE ZOLLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDY MARLENE LOCKHART

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 HANKS TRAIL
WOODWARD OK
73801-1213
US

IV. Provider business mailing address

PO BOX 1213 SUITE C
LAVERNE OK
73848-0783
US

V. Phone/Fax

Practice location:
  • Phone: 580-334-0912
  • Fax:
Mailing address:
  • Phone: 580-334-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: