Provider Demographics
NPI:1922370899
Name:WINGARD, SOISANGVANE ALINA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SOISANGVANE
Middle Name:ALINA
Last Name:WINGARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 TERRITORY LN
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-6503
Mailing Address - Country:US
Mailing Address - Phone:405-886-5655
Mailing Address - Fax:405-252-2545
Practice Address - Street 1:3345 TERRITORY LN
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-6503
Practice Address - Country:US
Practice Address - Phone:405-886-5655
Practice Address - Fax:405-252-2545
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96349163W00000X, 363LF0000X
WI23157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200429980AMedicaid