Provider Demographics
NPI:1639810039
Name:WHOLE HUMAN LIFE PLLC
Entity Type:Organization
Organization Name:WHOLE HUMAN LIFE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-996-1905
Mailing Address - Street 1:3030 NW EXPRESSWAY, SUITE 200 #536
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY,
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:888-338-3408
Mailing Address - Fax:909-752-5458
Practice Address - Street 1:3030 NW EXPRESSWAY, SUITE 200 #536
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY,
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:888-338-3408
Practice Address - Fax:909-752-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200793340AMedicaid
CABH8464505OtherDEA