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General NPI Number Information
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NPI Number | 1336690379
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Entity Type | Organization
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Legal Business Name | ABUNDANT WELLNESS
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 8787 N OWASSO EXPY SUITE J
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City | OWASSO
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State | OK
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Zip | 74055-4444
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Country | US
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Telephone | 918-516-2296
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Fax | 918-516-2965
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Provider Business Mailing Address
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Address Line | 8787 N OWASSO EXPY SUITE J
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City | OWASSO
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State | OK
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Zip | 74055-4444
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Country | US
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Telephone | 918-516-2296
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Fax | 918-516-2965
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORETTA A. FARRELL
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Credential | MD
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Telephone | 918-794-4652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | OK
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