Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99314 | TX |
NPI | 1013345982 |
---|---|
Provider Name | Pamela Brott |
First Address | Atoka, OK 74525-2043 |
Second Address | Atoka, OK 74525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2013 |
Last Update Date | 10/08/2018 |