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General NPI Number Information
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NPI Number | 1720884521
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Entity Type | Organization
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Legal Business Name | OPTIMA VIDA HEALTHCARE
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 16143 E 85TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-8410
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Country | US
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Telephone | 406-260-5603
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Fax | 779-204-2406
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Provider Business Mailing Address
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Address Line | 16143 E 85TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-8410
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Country | US
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Telephone | 406-260-5603
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Fax | 779-204-2406
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Authorized Official
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Title or Position | OWNER
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Name | SARINA HELTON
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Credential | NP
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Telephone | 406-260-5603
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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 |
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License Number State |
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