Provider Demographics
NPI:1346951076
Name:WAMBOLT, JULIA (APRN-CNP,CNM,,IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WAMBOLT
Suffix:
Gender:F
Credentials:APRN-CNP,CNM,,IBCLC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:731 12TH AVE NW STE 201
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5764
Mailing Address - Country:US
Mailing Address - Phone:580-226-3003
Mailing Address - Fax:580-298-3124
Practice Address - Street 1:731 12TH AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5764
Practice Address - Country:US
Practice Address - Phone:580-226-3003
Practice Address - Fax:580-298-3124
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0044894163WL0100X
OK205817176B00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No176B00000XOther Service ProvidersMidwife