Provider Demographics
NPI:1619643483
Name:MAGNOLIA HEALTH PLLC
Entity Type:Organization
Organization Name:MAGNOLIA HEALTH PLLC
Other - Org Name:MAGNOLIA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLWAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:918-794-0701
Mailing Address - Street 1:1919 S WHEELING AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5632
Mailing Address - Country:US
Mailing Address - Phone:918-794-0701
Mailing Address - Fax:
Practice Address - Street 1:1919 S WHEELING AVE STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5632
Practice Address - Country:US
Practice Address - Phone:918-794-0701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service