Provider Demographics
NPI:1588222525
Name:ADVANCED HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:918-261-4439
Mailing Address - Street 1:1252 E QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5637
Mailing Address - Country:US
Mailing Address - Phone:918-261-4439
Mailing Address - Fax:877-992-9262
Practice Address - Street 1:1252 E QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5637
Practice Address - Country:US
Practice Address - Phone:918-261-4439
Practice Address - Fax:877-992-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty