Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | OK |
NPI | 1003440744 |
---|---|
Provider Name | Brittany Menjivar |
First Address | El Reno, OK 73036-9125 |
Second Address | El Reno, OK 73036-9125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2020 |
Last Update Date | 02/03/2020 |