Individual
HETLEVIA R VILAR-JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
109 S MAIN ST, WETUMKA, OK 74883-4015
(405) 452-5400
(405) 452-3000
Mailing address
PO BOX 11457, BELFAST, ME 04915-4005
(405) 733-0313
(405) 733-0140
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23895
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200031400A
—
OK
01
—
200031400B
SOONERCARE-INDIVIDUAL
OK
Enumeration date
06/07/2006
Last updated
11/17/2019
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