Healthcare Provider Details

I. General information

NPI: 1992247449
Provider Name (Legal Business Name): RORY BREWSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 NW EXPRESSWAY
OKLAHOMA CITY OK
73162-6006
US

IV. Provider business mailing address

8325 NW EXPRESSWAY
OKLAHOMA CITY OK
73162-6006
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-7099
  • Fax: 405-773-9418
Mailing address:
  • Phone: 405-749-7099
  • Fax: 405-773-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0107758
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107758
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: