Healthcare Provider Details

I. General information

NPI: 1235995960
Provider Name (Legal Business Name): BRENDA EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 OAK
NORTH MIAMI OK
74358
US

IV. Provider business mailing address

PO BOX 258
NORTH MIAMI OK
74358-0258
US

V. Phone/Fax

Practice location:
  • Phone: 918-533-4401
  • Fax:
Mailing address:
  • Phone: 918-533-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: