Individual
WANDA KAYE BRAZEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FPMHNP
Contact information
Practice address
6655 S YALE AVE, LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL, TULSA, OK 74136-3326
(918) 491-3700
(918) 491-5740
Mailing address
PO BOX 21228, DEPARTMENT 31, TULSA, OK 74121-1228
(918) 491-3700
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
72748
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200329080A
—
OK
Enumeration date
03/01/2011
Last updated
07/28/2011
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