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General NPI Number Information
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NPI Number | 1790818631
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Entity Type | Individual
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Provider Name | JACQUELINE BRASHEAR
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 8270 E . 71ST ST.
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City | TULSA
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State | OK
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Zip | 74133-2908
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Country | US
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Telephone | 918-250-0180
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Fax | 918-250-8508
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Provider Business Mailing Address
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Address Line | 8270 E. 71ST ST.
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City | TULSA
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State | OK
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Zip | 74133-2908
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Country | US
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Telephone | 918-250-0180
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Fax | 918-250-8508
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 237987
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License Number State | OK
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