Provider Demographics
NPI:1093400749
Name:BUERSMEYER, PATRICIA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BUERSMEYER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:BUERSMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:708 REDVINE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4280
Mailing Address - Country:US
Mailing Address - Phone:405-831-3214
Mailing Address - Fax:
Practice Address - Street 1:708 REDVINE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4280
Practice Address - Country:US
Practice Address - Phone:405-831-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0063251163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty