Provider Demographics
NPI:1053619254
Name:WHITE, BREANNA LEA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:LEA
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2017 W I 35 FRONTAGE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8550
Mailing Address - Country:US
Mailing Address - Phone:405-757-3365
Mailing Address - Fax:405-757-3366
Practice Address - Street 1:2017 W I 35 FRONTAGE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8550
Practice Address - Country:US
Practice Address - Phone:405-757-3365
Practice Address - Fax:405-757-3366
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR81293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily