1548871528 NPI number — ELITE WELLNESS PLLC SARA BOTCHLET APRN-CNP

Table of content: MRS. LEANNE JOY CAREY RN (NPI 1497904254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548871528 NPI number — ELITE WELLNESS PLLC SARA BOTCHLET APRN-CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE WELLNESS PLLC SARA BOTCHLET APRN-CNP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548871528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16925 NE 23RD ST STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHOCTAW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73020-8410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-620-0049
Provider Business Mailing Address Fax Number:
405-281-5726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16925 NE 23RD ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHOCTAW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73020-8410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-620-0049
Provider Business Practice Location Address Fax Number:
405-281-5726
Provider Enumeration Date:
08/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BOTCHLET
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-620-0049

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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