Provider Demographics
NPI:1437648201
Name:WILBUR, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WILBUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:816 CROWN HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-9717
Mailing Address - Country:US
Mailing Address - Phone:405-209-2502
Mailing Address - Fax:
Practice Address - Street 1:816 CROWN HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-9717
Practice Address - Country:US
Practice Address - Phone:405-215-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR2170363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology