Provider Demographics
NPI:1992489926
Name:METAMORPHOSIS WELLNESS AND AESTHETICS LLC
Entity type:Organization
Organization Name:METAMORPHOSIS WELLNESS AND AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICKCOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-607-2261
Mailing Address - Street 1:8988 S SHERIDAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5035
Mailing Address - Country:US
Mailing Address - Phone:918-607-2261
Mailing Address - Fax:
Practice Address - Street 1:8988 S SHERIDAN RD STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5035
Practice Address - Country:US
Practice Address - Phone:918-607-2261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty