Individual
GWENDOLYN ANN WISDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
403 N THOMPSON, VINITA, OK 74301-7430
(918) 323-1572
Mailing address
403 N THOMPSON, VINITA, OK 74301
(918) 323-1572
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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