Healthcare Provider Details

I. General information

NPI: 1790262012
Provider Name (Legal Business Name): BROOKE NICHOL WEAVER ARNP-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S UTICA AVE
TULSA OK
74104-4243
US

IV. Provider business mailing address

30760 S CEDAR RIDGE DR
INOLA OK
74036-3055
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax:
Mailing address:
  • Phone: 918-636-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number107531
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: