Provider Demographics
NPI:1477381549
Name:PROMISE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:PROMISE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWOH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:405-816-7283
Mailing Address - Street 1:15912 BISON DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7738
Mailing Address - Country:US
Mailing Address - Phone:405-816-7283
Mailing Address - Fax:
Practice Address - Street 1:15912 BISON DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7738
Practice Address - Country:US
Practice Address - Phone:405-816-7283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty