Individual
MACKENZIE BRUBAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3029 W MAIN ST, JENKS, OK 74037-3465
(918) 701-2300
Mailing address
4908 S JUNIPER AVE, BROKEN ARROW, OK 74011-4422
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
210148
OK
Other
Enumeration date
09/01/2022
Last updated
09/01/2022
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