Organization
WELLNESS CLINIC AND MEDICAL SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE DEWBRE APRN-GNP (NURSE PRACTITIONER, OWNER)
(405) 527-4704
Entity
Organization
Contact information
Practice address
128 W MAIN ST, PURCELL, OK 73080-4220
(405) 527-4704
(405) 527-5976
Mailing address
PO BOX 269031, OKLAHOMA CITY, OK 73126-9031
(877) 485-4474
(405) 527-5976
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
49456
OK
Other
Enumeration date
03/17/2014
Last updated
10/30/2019
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