1275567695 NPI number — MS. LYN GLEZEN BRANT APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275567695 NPI number — MS. LYN GLEZEN BRANT APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANT
Provider First Name:
LYN
Provider Middle Name:
GLEZEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275567695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 NW 39TH EXPRESSWAY
Provider Second Line Business Mailing Address:
DEACONESS FAMILY CARE, BETHANY
Provider Business Mailing Address City Name:
BETHANY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
70008-8650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-455-4778
Provider Business Mailing Address Fax Number:
405-789-7978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 NW 39TH EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHANY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73008-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-789-2441
Provider Business Practice Location Address Fax Number:
405-789-7978
Provider Enumeration Date:
07/10/2006

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: 363L00000X , with the licence number:  R0024436 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: R0024436 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R0024436 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CH9820 . This is a "MEDICARE RR GROUP #" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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