10zero5 Ventures, INC
Family Medicine in Shawnee, OK. Organization (NPI-2).
NPI number1790455590
StatusActive
Last updated in NPPESSep 14, 2021
Details
- NPI
- 1790455590
- Entity type
- Organization (NPI-2)
- Legal business name
- 10zero5 Ventures, INC
- Organization subpart
- Yes
- Enumeration date
- Sep 14, 2021
- Certification date
- Sep 14, 2021
- Last updated
- Sep 14, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Magnolia Wellness & Aesthetics (Doing Business As)
Practice location
4409 N Kickapoo Ave Ste 121Shawnee, OK 74804-1225
Phone 405-585-0475 · Fax 855-685-0408
Mailing address
4409 N Kickapoo Ave Ste 121Shawnee, OK 74804-1225
Phone 405-585-0475 · Fax 855-685-0408
Authorized official
Katie Luanne Frost
NP/Owner
4055850485
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