1952516114 NPI number — MRS. BRANDI CHANELLE WOODS P.T.A.

Table of content: MRS. BRANDI CHANELLE WOODS P.T.A. (NPI 1952516114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952516114 NPI number — MRS. BRANDI CHANELLE WOODS P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
BRANDI
Provider Middle Name:
CHANELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTIAN
Provider Other First Name:
BRANDI
Provider Other Middle Name:
CHANELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952516114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11000 NW 102ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUKON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73099-8398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-283-0285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 N SANTA FE AVE
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-9126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-840-2903
Provider Business Practice Location Address Fax Number:
405-840-3256
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  804 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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