Provider Demographics
NPI:1679301899
Name:ANDERSON, BROOKE ANNE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 E 76TH PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-3508
Mailing Address - Country:US
Mailing Address - Phone:539-222-7756
Mailing Address - Fax:
Practice Address - Street 1:10633 E 36TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2504
Practice Address - Country:US
Practice Address - Phone:539-222-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist