Provider Demographics
NPI:1396772158
Name:MONTES, GWENDOLYN EVON (ARNP)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:EVON
Last Name:MONTES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:DAY
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1305 N ASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9136
Mailing Address - Country:US
Mailing Address - Phone:918-951-3259
Mailing Address - Fax:
Practice Address - Street 1:334 E APACHE ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-3704
Practice Address - Country:US
Practice Address - Phone:918-585-1550
Practice Address - Fax:918-728-8686
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0047676363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health