Provider Demographics
NPI:1124787106
Name:KROWS, WENDY SUE
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:KROWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5324
Mailing Address - Country:US
Mailing Address - Phone:405-249-9767
Mailing Address - Fax:
Practice Address - Street 1:133 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5324
Practice Address - Country:US
Practice Address - Phone:405-249-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOTHEROtherOTHER