Individual
JULIA WAMBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP,CNM,,IBCLC
Contact information
Practice address
731 12TH AVE NW STE 201, ARDMORE, OK 73401-5764
(580) 226-3003
(580) 298-3124
Mailing address
731 12TH AVE NW STE 201, ARDMORE, OK 73401-5764
(580) 226-3003
(580) 298-3124
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
R0044894
OK
176B00000X
Midwife
205817
OK
363LW0102X
Women's Health Nurse Practitioner
Primary
205817
OK
Other
Enumeration date
12/13/2022
Last updated
03/14/2023
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