Healthcare Provider Details

I. General information

NPI: 1356674451
Provider Name (Legal Business Name): WENDY D MCCONNELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 PROFESSIONAL CIR
YUKON OK
73099-6314
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-494-9300
  • Fax: 405-494-9325
Mailing address:
  • Phone: 405-494-9300
  • Fax: 405-494-9325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5696
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5696
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: