=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083588412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VENUS AESTHETICS AND WELLNESS OF TULSA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2025
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7233 S 85TH EAST AVE STE 100
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-720-4957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7233 S 85TH EAST AVE STE 100
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-720-4957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DONALD R BROWN JR.
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 918-720-4957
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------