Provider Demographics
NPI:1255804316
Name:ISABELLE ZLATNIK, APRN-CNP, PLLC
Entity type:Organization
Organization Name:ISABELLE ZLATNIK, APRN-CNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-248-8000
Mailing Address - Street 1:4411 W GORE BLVD STE B1
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5977
Mailing Address - Country:US
Mailing Address - Phone:580-248-8000
Mailing Address - Fax:580-248-8001
Practice Address - Street 1:4411 W GORE BLVD STE B1
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-248-8000
Practice Address - Fax:580-248-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200798930AMedicaid