Provider Demographics
NPI:1558802231
Name:ENTOURAGE TESTOSTERONE AND WEIGHT LOSS CLINICS LLC
Entity Type:Organization
Organization Name:ENTOURAGE TESTOSTERONE AND WEIGHT LOSS CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:918-236-1873
Mailing Address - Street 1:6808 S MEMORIAL DR
Mailing Address - Street 2:SUITE # 336
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2033
Mailing Address - Country:US
Mailing Address - Phone:918-236-1873
Mailing Address - Fax:918-286-6283
Practice Address - Street 1:6808 S MEMORIAL DR
Practice Address - Street 2:SUITE # 336
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2033
Practice Address - Country:US
Practice Address - Phone:918-236-1873
Practice Address - Fax:918-286-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty