Provider Demographics
NPI:1528318623
Name:GIRTEN, WENDY LYN
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LYN
Last Name:GIRTEN
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 1:8001 15TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-9702
Mailing Address - Country:US
Mailing Address - Phone:405-590-5571
Mailing Address - Fax:
Practice Address - Street 1:1600 E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5787
Practice Address - Country:US
Practice Address - Phone:405-262-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)