MEDICARE: SANA WOUND CARE OKLAHOMA, LLC

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	207Q00000X	Family Medicine Physician
2	163WW0000X	Wound Care Registered Nurse

General Provider Information

NPI Number	:	1841002243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANA WOUND CARE OKLAHOMA, LLC

Provider Business Mailing Address
First Line	:	18 W COLT SQUARE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703
Country	:	US
Telephone Number	:	479-480-6677
Fax Number	:	479-485-3752

Provider Business Practice Location Address
First Line	:	3150 E 41ST ST STE 108A
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-3739
Country	:	US
Telephone Number	:	479-480-6677
Fax Number	:	479-485-3752

Authorized Official
Title or Position	:	OWNER
Name	:	KATINKA VAN DER MERWE
Credential	:	DC
Telephone Number	:	479-480-6677

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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