Healthcare Provider Details

I. General information

NPI: 1487907747
Provider Name (Legal Business Name): BRANDY MARLIESE HUTCHISON RMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N DENVER AVE
TULSA OK
74103-1806
US

IV. Provider business mailing address

650 S PEORIA AVE
TULSA OK
74120-4429
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1200
  • Fax: 918-560-1399
Mailing address:
  • Phone: 918-587-9471
  • Fax: 918-560-1399

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: