OrganizationActive
Modify, PLLC
NPI 1871295774 · Adult Health Clinical Nurse Specialist · Tulsa, OK
Provider details
- NPI number
- 1871295774
- Entity type
- Organization
- Primary specialty
- Adult Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Amanda Wyatt, Owner(918) 857-2135
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Health Service Clinic/Center261QH0100X
Ambulatory Health Care Facilities
Practice location
7804 E 108th St Ste a
Tulsa, OK 74133-7423
Phone: (918) 857-2135
Approximate (ZIP-level) locationGet directions
Mailing address
8263 S Harvard Ave # 715
Tulsa, OK 74137-1614
Registry dates
- Enumerated
- 2023-03-22
- Last updated
- 2023-06-12
- Certified
- 2023-06-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.