| Organization Name: | CHOCTAW WOMENS CLINIC PLLC |
| NPI Number: | 1194134726 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SARA MARIE BOTCHLET (OWNER) |
| Mailing Address: | 14890 Se 29th St Suite 106 Choctaw |
| State: | OK US |
| Postal Code: | 730203515 |
| Phone Number: | 4056200049 |
| Fax Number: | 4052349476 |
| NPI Enumeration Date: | 08/07/2014 |
| NPI Last Update Date: | 08/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |