Healthcare Provider Details

I. General information

NPI: 1982160248
Provider Name (Legal Business Name): BROOKE OSTBERG NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 2ND ST
SKIATOOK OK
74070-1211
US

IV. Provider business mailing address

713 E BEAVER ST
JENKS OK
74037-4314
US

V. Phone/Fax

Practice location:
  • Phone: 918-396-1262
  • Fax:
Mailing address:
  • Phone: 918-240-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110969
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: