Healthcare Provider Details

I. General information

NPI: 1700692753
Provider Name (Legal Business Name): WREN LEA RAINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S WASHITA AVE
WYNNEWOOD OK
73098-7820
US

IV. Provider business mailing address

PO BOX 285
ELMORE CITY OK
73433-0285
US

V. Phone/Fax

Practice location:
  • Phone: 405-306-1777
  • Fax:
Mailing address:
  • Phone: 405-207-8547
  • 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: