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General NPI Number Information
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NPI Number | 1407390115
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Entity Type | Organization
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Legal Business Name | EMPOWER PEDIATRICS
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 9659 RIVERSIDE PKWY
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City | TULSA
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State | OK
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Zip | 74137-7398
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Country | US
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Telephone | 918-299-5040
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Fax | 918-299-9041
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Provider Business Mailing Address
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Address Line | 9659 RIVERSIDE PKWY
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City | TULSA
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State | OK
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Zip | 74137-7398
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Country | US
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Telephone | 918-299-5040
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Fax | 918-299-9041
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Authorized Official
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Title or Position | MD/PHYSICIAN
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Name | JENNIFER C. WOLF
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Credential | M.D.
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Telephone | 918-299-5040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20296
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License Number State | OK
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