Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 80718 | OK |
NPI | 1003196684 |
---|---|
Provider Name | Casie Nicole Brim |
First Address | Tulsa, OK 74104-5635 |
Second Address | Tulsa, OK 74104-5638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2011 |
Last Update Date | 12/09/2016 |