Provider Demographics
NPI:1558252361
Name:WYANDOTTE NATION
Entity type:Organization
Organization Name:WYANDOTTE NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COMPLIANCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:918-678-3244
Mailing Address - Street 1:1 TURTLE DR
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:OK
Mailing Address - Zip Code:74370-2114
Mailing Address - Country:US
Mailing Address - Phone:918-678-6482
Mailing Address - Fax:
Practice Address - Street 1:1 TURTLE DR
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:OK
Practice Address - Zip Code:74370-2114
Practice Address - Country:US
Practice Address - Phone:918-678-3244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy