Provider Demographics
NPI:1487347878
Name:MADEWELL, EMILY DAWN (OPTIMAL)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:DAWN
Last Name:MADEWELL
Suffix:
Gender:F
Credentials:OPTIMAL
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DAWN
Other - Last Name:MADEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OPTIMAL
Mailing Address - Street 1:6333 E SKELLY DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6106
Mailing Address - Country:US
Mailing Address - Phone:918-664-4224
Mailing Address - Fax:
Practice Address - Street 1:6333 E SKELLY DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6106
Practice Address - Country:US
Practice Address - Phone:918-664-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist