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General NPI Number Information
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NPI Number | 1417640582
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Entity Type | Organization
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Legal Business Name | WILLOW MEDICAL LLC
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 12806 E 86TH PL N STE A
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City | OWASSO
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State | OK
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Zip | 74055-2688
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Country | US
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Telephone | 539-208-5069
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Fax | 539-208-5440
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Provider Business Mailing Address
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Address Line | 12806 E 86TH PL N STE A
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City | OWASSO
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State | OK
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Zip | 74055-2688
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Country | US
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Telephone | 539-208-5069
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Fax | 539-208-5440
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Authorized Official
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Title or Position | APRN, FNP-C
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Name | PAULA MOORMAN
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Credential | APRN, FNP-C
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Telephone | 539-208-5069
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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 |
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