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Oklahoma Board of Medical Licensure and Supervision

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WAGNER, MARLO MICHELLE       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: TULSA VA OUTPATIENT CLINIC
9322 E 41ST ST
TULSA OK 74145

Address last updated on 10/10/2006
Phone #: (918) 764-7209
Fax #:
County: TULSA
License: 1083
Dated: 11/1/2000
Expires: 10/31/2009
License Type: Licensed Dietitian
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year:
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
TULSA VA OUTPATIENT CLINIC
9322 E 41ST ST
TULSA OK 74145

Phone #: (918) 764-7209
Fax #:

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