Provider Demographics
NPI:1346518255
Name:WARDWORTH, DEBBIE L
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:L
Last Name:WARDWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LINDSAY LN
Mailing Address - Street 2:P.O. BOX 462
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-3544
Mailing Address - Country:US
Mailing Address - Phone:405-343-1734
Mailing Address - Fax:
Practice Address - Street 1:2800 LINDSAY LN
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3544
Practice Address - Country:US
Practice Address - Phone:405-343-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor