Individual
JOSIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(918) 582-1972
Mailing address
5302 S HARVARD AVE, H, TULSA, OK 74135
(314) 602-3666
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/02/2025
Last updated
07/02/2025
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