# SUNNYLANE MEDICAL CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255922811
- **Authorized official:** BRADEN PETERSON NP (OWNER)
- **Authorized official phone:** (405) 455-5330

## Contact information

- **Practice address:** 3916 S SUNNYLANE RD, DEL CITY, OK 73115-3656
- **Practice address phone:** (405) 455-5330
- **Mailing address:** 3916 S SUNNYLANE RD, DEL CITY, OK 73115-3656
- **Mailing address phone:** (405) 455-5330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 01/27/2021
- **Last updated:** 08/14/2023