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General NPI Number Information
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NPI Number | 1891292009
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Entity Type | Individual
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Provider Name | DEBBIE OATMAN-BROADNAX
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Gender | Female
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 6161 TRAIL GLEN DR APT 129
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City | DALLAS
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State | TX
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Zip | 75217-5538
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Country | US
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Telephone | 214-881-5485
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Fax |
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Provider Business Mailing Address
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Address Line | 6161 TRAIL GLEN DR APT 129
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City | DALLAS
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State | TX
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Zip | 75217-5538
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 207457
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License Number State | TX
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