| Willow Medical Llc | |
|
12806 E 86th Pl N Ste A Owasso OK 74055-2688 | |
| (539) 208-5069 | |
| (539) 208-5440 |
| Full Name | Willow Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 12806 E 86th Pl N Ste A, Owasso, Oklahoma |
| Authorized Official Name and Position | Paula Moorman (APRN, FNP-C) |
| Authorized Official Contact | 5392085069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Medical Llc 12806 E 86th Pl N Ste A Owasso OK 74055-2688 Ph: (539) 208-5069 | Willow Medical Llc 12806 E 86th Pl N Ste A Owasso OK 74055-2688 Ph: (539) 208-5069 |
| NPI Number | 1417640582 |
|---|---|
| Provider Enumeration Date | 06/02/2023 |
| Last Update Date | 03/13/2024 |
| Medicare PECOS PAC ID | 1658723176 |
|---|---|
| Medicare Enrollment ID | O20240122000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417640582 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Paula Dee Moorman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336772169 PECOS PAC ID: 6608292180 Enrollment ID: I20200813003601 |
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