MEDICARE: ALTHEA MED SPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1669322236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTHEA MED SPA

Provider Business Mailing Address
First Line	:	1320 S MAIN ST
Second Line	:
City	:	SAPULPA
State	:	OK
Zip	:	74066-5544
Country	:	US
Telephone Number	:	539-432-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 S MAIN ST
Second Line	:
City	:	SAPULPA
State	:	OK
Zip	:	74066-5544
Country	:	US
Telephone Number	:	539-432-1808
Fax Number	:

Authorized Official
Title or Position	:	OWNER/APRN
Name	:	LAUREN AUBREY ROVANG
Credential	:	DNP
Telephone Number	:	918-671-6210

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ALTHEA MED SPA ” Practice Location

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