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General NPI Number Information
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NPI Number | 1891204244
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Entity Type | Organization
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Legal Business Name | LAURA'S TOTAL BODY SOLUTIONS SPA TULSA LLC
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 09/28/2017
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Provider Practice Location Address
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Address Line | 7127 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-6308
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Country | US
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Telephone | 918-698-1866
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Fax |
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Provider Business Mailing Address
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Address Line | 29560 S PINE VALLEY DR
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City | CATOOSA
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State | OK
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Zip | 74015-6149
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | LAURA JEAN WIDNEY
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Credential |
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Telephone | 918-770-2271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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