Individual
JOHNNIE BRASUELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.R.N.P.
Contact information
Practice address
1125 E CLEVELAND AVE, SAPULPA, OK 74066-4641
(918) 224-9310
(918) 756-3993
Mailing address
PO BOX 400, OKMULGEE, OK 74447-0400
(918) 756-3334
(918) 756-3993
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0020383
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720383
—
OK
Enumeration date
07/13/2006
Last updated
07/09/2007
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