Individual
STACI BROUGHTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5101 N 34TH ST, BROKEN ARROW, OK 74014-1710
(918) 605-6796
Mailing address
PO BOX 618, COPPELL, TX 75019-0618
(469) 426-8683
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
145868
OK
246ZS0410X
Surgical Technologist
117099
OK
Other
Enumeration date
05/06/2013
Last updated
10/15/2013
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