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General NPI Number Information
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NPI Number | 1205640539
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Entity Type | Individual
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Provider Name | BROOKE BOETTLER
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Gender | Female
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1200 CHILDRENS AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-4637
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Country | US
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Telephone | 405-271-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 12641 HERITAGE OAKS DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-2092
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 221938
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License Number State | OK
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