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NPI Code Detail

MEDICARE: SHANNON BRUEY

MEDICARE: SHANNON BRUEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse96735OK
2363L00000XNurse PractitionerR0096735OK

General Provider Information

NPI Number : 1265985717
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON BRUEY
Provider Business Mailing Address
First Line : 1202 W FARM RD
Second Line :
City : STILLWATER
State : OK
Zip : 74078-2000
Country : US
Telephone Number : 405-744-7665
Fax Number : 405-744-6556
Provider Business Practice Location Address
First Line : 1202 W FARM RD
Second Line :
City : STILLWATER
State : OK
Zip : 74078-2000
Country : US
Telephone Number : 405-744-7665
Fax Number : 405-744-6556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2016
Last Update Date : 09/11/2025

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Directions to “ SHANNON BRUEY ” Practice Location

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