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General NPI Number Information
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NPI Number | 1982364121
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Entity Type | Individual
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Provider Name | BRENNA JOSEFINA GUSMAN
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Gender | Female
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 5310 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74135-5018
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Country | US
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Telephone | 918-600-3100
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Fax | 918-560-1399
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Provider Business Mailing Address
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Address Line | 9703 S 92ND EAST AVE
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City | TULSA
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State | OK
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Zip | 74133-6133
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Country | US
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Telephone | 214-869-9417
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OK
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