Provider Demographics
NPI:1679038996
Name:SPOTTEDWOLF, LOUELLA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LOUELLA
Middle Name:
Last Name:SPOTTEDWOLF
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5674 S 445
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:OK
Mailing Address - Zip Code:74365-2765
Mailing Address - Country:US
Mailing Address - Phone:918-530-8025
Mailing Address - Fax:
Practice Address - Street 1:CLAREMORE INDIAN HOSPITAL
Practice Address - Street 2:101 S. MOORE AVENUE
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019
Practice Address - Country:US
Practice Address - Phone:918-342-6538
Practice Address - Fax:918-342-6312
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56173163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health