Provider Demographics
NPI:1609450287
Name:FIXICO, WENDY GALE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:GALE
Last Name:FIXICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395200 W 2900 RD
Mailing Address - Street 2:
Mailing Address - City:OCHELATA
Mailing Address - State:OK
Mailing Address - Zip Code:74051-2463
Mailing Address - Country:US
Mailing Address - Phone:918-535-6000
Mailing Address - Fax:918-535-6096
Practice Address - Street 1:395200 W 2900 RD
Practice Address - Street 2:
Practice Address - City:OCHELATA
Practice Address - State:OK
Practice Address - Zip Code:74051-2463
Practice Address - Country:US
Practice Address - Phone:918-535-6000
Practice Address - Fax:918-535-6096
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0122641163WX0106X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health