Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R0075445 | OK |
NPI | 1033156096 |
---|---|
Provider Name | Mrs. Mandi L Brown |
First Address | Norman, OK 73070-1330 |
Second Address | Oklahoma City, OK 73170-7107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 30/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | OK |