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General NPI Number Information
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NPI Number | 1144673112
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Entity Type | Organization
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Legal Business Name | THE WELLNESS CLINIC
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 3562 E 51ST ST
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City | TULSA
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State | OK
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Zip | 74135-3518
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Country | US
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Telephone | 918-313-7351
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Fax |
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Provider Business Mailing Address
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Address Line | 3562 E 51ST ST
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City | TULSA
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State | OK
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Zip | 74135-3518
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Country | US
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Telephone | 918-313-7351
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ANNA LILIA PINA
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Credential | APRN, NP-C
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Telephone | 918-734-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 88067
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License Number State | OK
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