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General NPI Number Information
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NPI Number | 1841523594
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Entity Type | Individual
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Provider Name | BRANDI SHANTIL HAMM NP
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Gender | Female
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5795 S ELM PL
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City | BROKEN ARROW
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State | OK
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Zip | 74011-4893
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Country | US
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Telephone | 918-716-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 9276 S 259TH EAST AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74014-7828
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Country | US
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Telephone | 918-812-0562
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R0083172
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License Number State | OK
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