Organization
CLINIC AT WELLSTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SISNE LIBRE' GROFF (OWNER/OPERATOR)
(918) 906-9643
Entity
Organization
Contact information
Practice address
309 WEST 2ND STREET, SUITE B, WELLSTON, OK 74881
(405) 356-3035
(405) 356-3035
Mailing address
PO BOX 708, WELLSTON, OK 74881-0708
(918) 906-9643
(405) 356-4199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100227020A
—
OK
05
—
200002570A
—
OK
Enumeration date
06/29/2017
Last updated
08/23/2017
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