Basic Information
| Provider Information | |||||||||
| NPI: | 1649942319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEEKS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1203 OAK AVE | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738014657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803778680 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5050 WILLIAMS AVE | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738017713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802569700 | ||||||||
| FaxNumber: | 5802569704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2021 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | L0047709 | OK | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.