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General NPI Number Information
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NPI Number | 1215222666
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Entity Type | Individual
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Provider Name | JANENA GRACE WILSON FNP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 806 MANVEL AVE
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City | CHANDLER
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State | OK
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Zip | 74834
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Country | US
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Telephone | 405-258-9955
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Fax | 405-258-9930
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Provider Business Mailing Address
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Address Line | 806 MANVEL AVE
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City | CHANDLER
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State | OK
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Zip | 74834-3858
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Country | US
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Telephone | 405-258-9955
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Fax | 405-258-9930
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 86757
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License Number State | OK
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