Organization
MAIN STREET FAMILY HEALTHCARE NURSE PRACTITIONER CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRONWYN L. HOWARD APRN-CNP (OWNER/OPERATOR)
(918) 950-5053
Entity
Organization
Contact information
Practice address
309 W MAIN ST, STROUD, OK 74079-3611
(918) 987-0067
Mailing address
309 W MAIN ST, P.O. BOX 968, STROUD, OK 74079-3611
(918) 987-0067
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R0052024
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200121770A
—
OK
05
—
2005513360A
—
OK
Enumeration date
12/27/2014
Last updated
12/18/2015
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