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NPI Code Detail

MEDICARE: SUSAN DOROTHY BRECHEEN RN

MEDICARE: SUSAN DOROTHY BRECHEEN RN
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 Nurse96698OK

General Provider Information

NPI Number : 1285949636
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN DOROTHY BRECHEEN RN
Provider Business Mailing Address
First Line : RR 5 BOX 1375
Second Line :
City : COALGATE
State : OK
Zip : 74538-9548
Country : US
Telephone Number : 580-428-3407
Fax Number :
Provider Business Practice Location Address
First Line : 1308 CRADDUCK RD
Second Line :
City : ADA
State : OK
Zip : 74820-8442
Country : US
Telephone Number : 580-332-3699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2010
Last Update Date : 08/10/2010

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