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General NPI Number Information
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NPI Number | 1538818000
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Entity Type | Individual
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Provider Name | HALEIGH BROOKE WISOTSKY APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 9716 RIVERSIDE PKWY
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City | TULSA
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State | OK
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Zip | 74137-7447
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Country | US
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Telephone | 918-528-4897
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Fax |
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Provider Business Mailing Address
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Address Line | 738 W 97TH ST S
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City | JENKS
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State | OK
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Zip | 74037-3406
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Country | US
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Telephone | 918-809-3514
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 207213
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License Number State | OK
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