Individual
MRS. NICHOLETTE BROSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1520 SW 1ST ST, WAGONER, OK 74467-4839
(918) 704-7825
Mailing address
5130 S HUDSON PL, TULSA, OK 74135-7509
(918) 704-7825
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/25/2019
Last updated
11/09/2020
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