Individual
BENJAMIN WAGGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4815 S HARVARD AVE STE 360, TULSA, OK 74135-3077
(918) 876-0606
(918) 876-0604
Mailing address
PO BOX 311, JENKS, OK 74037-0311
(918) 876-0606
(918) 876-0604
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2024027381
OK
Other
Enumeration date
06/21/2024
Last updated
06/21/2024
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