Provider Demographics
NPI:1346836137
Name:CHANDRA AKE APRN-CNP, LLC
Entity Type:Organization
Organization Name:CHANDRA AKE APRN-CNP, LLC
Other - Org Name:WILLOW HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:580-290-5055
Mailing Address - Street 1:916 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:SEILING
Mailing Address - State:OK
Mailing Address - Zip Code:73663-6345
Mailing Address - Country:US
Mailing Address - Phone:580-922-1385
Mailing Address - Fax:435-586-5368
Practice Address - Street 1:1611 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3064
Practice Address - Country:US
Practice Address - Phone:580-290-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANDRA AKE APRN-CNP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-15
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care