Provider Demographics
NPI:1548871528
Name:ELITE WELLNESS PLLC SARA BOTCHLET APRN-CNP
Entity type:Organization
Organization Name:ELITE WELLNESS PLLC SARA BOTCHLET APRN-CNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTCHLET
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-620-0049
Mailing Address - Street 1:16925 NE 23RD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8410
Mailing Address - Country:US
Mailing Address - Phone:405-620-0049
Mailing Address - Fax:405-281-5726
Practice Address - Street 1:16925 NE 23RD ST STE 103
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8410
Practice Address - Country:US
Practice Address - Phone:405-620-0049
Practice Address - Fax:405-281-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty