Healthcare Provider Details

I. General information

NPI: 1730546953
Provider Name (Legal Business Name): BETHANIE LOREN BRYANT CD(DONA), CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANIE LOREN VERDUZCO CD(DONA), CLC

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4938 S DETROIT AVE
TULSA OK
74105-4610
US

IV. Provider business mailing address

4938 S DETROIT AVE
TULSA OK
74105-4610
US

V. Phone/Fax

Practice location:
  • Phone: 918-938-3436
  • Fax:
Mailing address:
  • Phone: 918-938-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: